Department of Neurosurgery, Inner Mongolia Xing'an Meng People's Hospital, Xing'an 137400, Inner Mongolia, China.
J Healthc Eng. 2022 Jan 25;2022:7796700. doi: 10.1155/2022/7796700. eCollection 2022.
Successful mechanical thrombectomy (MT) requires reliable, noninvasive selection criteria. We aimed to investigate the association of collateral status and clinical outcomes after MT in patients with ischemic stroke due to anterior circulation occlusion.
109 patients with poor collaterals and 110 aged, sex-matched patients with good collaterals were enrolled in the study. Collateral circulation was estimated by the CT angiography with a 0-3 scale. The collateral status was categorized as poor collaterals (scores 0-1) and good collaterals (scores 2-3). The reperfusion was assessed by the modified Treatment in Cerebral Infarction scale (mTICI, score 0/1/2a/2b/3). The clinical outcomes included the scores on the modified Rankin scale (mRS, ranging from 0 to 6) and death 90 days after mechanical thrombectomy.
Patients with greater scores of collateral status were more likely to achieve successful reperfusion (mTICI 2b/3). Patients with good collaterals were significantly associated with a higher chance of achieving mRS of 0-1 at 90 days (adjusted ORs: 4.55; 95% CI: 3.17-7.24; and < 0.001) and a lower risk of death at 90 days (adjusted ORs: 0.87; 95% CI: 4.0%-28.0%; and = 0.012) compared to patients with poor collaterals. In subgroup analyses, patients with statin use seem to benefit more from the effect of collateral status on good mRS (≤2).
Among patients with acute ischemic stroke caused by anterior circulation occlusion, better collateral status is associated with higher scores on mRS and lower mortality after mechanical thrombectomy. Statin use might have an interaction with the effect of collateral status.
成功的机械取栓（MT）需要可靠的、无创的选择标准。本研究旨在探讨前循环闭塞引起的缺血性卒中患者侧支循环状态与 MT 后临床结局的相关性。
本研究纳入了 109 例侧支循环不良患者和 110 例年龄、性别匹配的侧支循环良好患者。采用 CT 血管造影（CTA）评估侧支循环，侧支循环评分 0-3 分。侧支循环状态分为侧支循环不良（评分 0-1）和侧支循环良好（评分 2-3）。通过改良脑梗死治疗评分（mTICI）评估再灌注情况，评分 0/1/2a/2b/3。临床结局包括改良 Rankin 量表（mRS）评分（0-6 分）和机械取栓后 90 天的死亡率。
侧支循环状态评分较高的患者更有可能实现成功再灌注（mTICI 2b/3）。侧支循环良好的患者在 90 天 mRS 为 0-1 的可能性明显更高（调整后的 OR：4.55；95%CI：3.17-7.24； < 0.001），90 天死亡率更低（调整后的 OR：0.87；95%CI：4.0%-28.0%； = 0.012）。亚组分析显示，他汀类药物治疗的患者似乎从侧支循环状态对良好 mRS（≤2）的影响中获益更多。
在前循环闭塞引起的急性缺血性卒中患者中，较好的侧支循环状态与 MT 后 mRS 评分较高和死亡率较低相关。他汀类药物的使用可能与侧支循环状态的作用存在交互作用。
