Sim Jae Eun, Chung Jong-Won, Seo Woo-Keun, Bang Oh Young, Kim Gyeong-Moon
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Neurol. 2022 May 13;13:863483. doi: 10.3389/fneur.2022.863483. eCollection 2022.
Collateral flow in acute ischemic stroke is known as a predictor of treatment outcome and long-term prognosis. However, factors determining the initial collateral flow remain unclear. We investigated factors related to collateral flow in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO) and further analyzed the results according to stroke etiology.
This was a retrospective study using prospective stroke registry data from a single university hospital from October 2014 to May 2021. AIS-LVO with middle cerebral artery M1 occlusion identified by pre-treatment multiphasic computed tomography angiography was included. Collateral flow score was graded on a 6-point ordinal scale according to pial arterial filling.
A total of 74 patients [cardioembolism (CE): 57; large artery atherosclerosis (LAA): 17] was included. The mean age of all patients was 72.2 ± 11.7 years, and 37.8 % ( = 28) were men. Multivariate regression analysis showed that initial SBP [odds ratio (OR): 0.994; 95% confidence interval (): 0.990-0.998; = 0.002] and stroke etiology (: 0.718; 95% : 0.548-0.940; = 0.019) were independent factors of the collateral flow grade. Collateral flow grade was independently associated with initial SBP in the CE group (: 0.993; 95% : 0.989-0.998; = 0.004) but not in the LAA group (: 0.992; 95% : 0.980-1.004; = 0.218). Initial SBP was significantly correlated with NIHSS score in the CE group but not in the LAA group ( = 0.091, = 0.023; = 0.043, = 0.426, respectively).
Elevated initial SBP was associated with poor cerebral collateral flow and more severe symptoms in the CE group, but not in the LAA group in patients with AIS-LVO. These findings suggest differential effects of initial SBP elevation on collateral flow by stroke subtypes.
急性缺血性卒中的侧支循环是治疗效果和长期预后的预测指标。然而，决定初始侧支循环的因素仍不清楚。我们研究了大动脉闭塞所致急性缺血性卒中（AIS-LVO）患者侧支循环的相关因素，并根据卒中病因进一步分析了结果。
这是一项回顾性研究，使用了2014年10月至2021年5月来自一家大学医院的前瞻性卒中登记数据。纳入经治疗前多期计算机断层血管造影确定为大脑中动脉M1段闭塞的AIS-LVO患者。根据软脑膜动脉充盈情况，侧支循环评分采用6分有序量表进行分级。
共纳入74例患者[心源性栓塞（CE）：57例；大动脉粥样硬化（LAA）：17例]。所有患者的平均年龄为72.2±11.7岁，男性占37.8%（n = 28）。多因素回归分析显示，初始收缩压[比值比（OR）：0.994；95%置信区间（CI）：0.990 - 0.998；P = 0.002]和卒中病因（P：0.718；95%CI：0.548 - 0.940；P = 0.019）是侧支循环分级的独立因素。在CE组，侧支循环分级与初始收缩压独立相关（P：0.993；95%CI：0.989 - 0.998；P = 0.004），而在LAA组则无相关性（P：0.992；95%CI：0.980 - 1.004；P = 0.218）。在CE组，初始收缩压与美国国立卫生研究院卒中量表（NIHSS）评分显著相关，而在LAA组则无相关性（分别为r = 0.091，P = 0.023；r = 0.043，P = 0.426）。
在AIS-LVO患者中，初始收缩压升高与CE组较差的脑侧支循环及更严重的症状相关，但与LAA组无关。这些发现提示初始收缩压升高对不同卒中亚型侧支循环的影响存在差异。
