Guisado-Alonso Daniel, Camps-Renom Pol, Delgado-Mederos Raquel, Granell Esther, Prats-Sánchez Luis, Martínez-Domeño Alejandro, Guasch-Jiménez Marina, Acosta M Victoria, Ramos-Pachón Anna, Martí-Fàbregas Joan
Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain.
Department of Radiology, UDIAT Corporació Sanitària Parc Taulí, Sabadell, Spain.
Front Neurol. 2022 Aug 9;13:944779. doi: 10.3389/fneur.2022.944779. eCollection 2022.
We aimed to determine whether the degree of collateral circulation is associated with blood pressure at admission in acute ischemic stroke patients treated with endovascular treatment and to determine its prognostic value.
We evaluated patients with anterior large vessel occlusion treated with endovascular treatment in a single-center prospective registry. We collected clinical and radiological data. Automated and validated software (Brainomix Ltd., Oxford, UK) was used to generate the collateral score (CS) from the baseline single-phase CT angiography: 0, filling of ≤10% of the occluded MCA territory; 1, 11-50%; 2, 51-90%; 3, >90%. When dichotomized, we considered that CS was good (CS = 2-3), or poor (CS = 0-1). We performed bivariate and multivariable ordinal logistic regression analysis to predict CS categories in our population. The secondary outcome was to determine the influence of automated CS on functional outcome at 3 months. We defined favorable functional outcomes as mRS 0-2 at 3 months.
We included 101 patients with a mean age of 72.1 ± 13.1 years and 57 (56.4%) of them were women. We classified patients into 4 groups according to the CS: 7 patients (6.9%) as CS = 0, 15 (14.9%) as CS = 1, 43 (42.6%) as CS = 2 and 36 (35.6%) as CS = 3. Admission systolic blood pressure [aOR per 10 mmHg increase 0.79 (95% CI 0.68-0.92)] and higher baseline NIHSS [aOR 0.90 (95% CI, 0.84-0.96)] were associated with a worse CS. The OR of improving 1 point on the 3-month mRS was 1.63 (95% CI, 1.10-2.44) favoring a better CS ( = 0.016).
In acute ischemic stroke patients with anterior large vessel occlusion treated with endovascular treatment, admission systolic blood pressure was inversely associated with the automated scoring of CS on baseline CT angiography. Moreover, a good CS was associated with a favorable outcome.
我们旨在确定在接受血管内治疗的急性缺血性卒中患者中，侧支循环程度是否与入院时的血压相关，并确定其预后价值。
我们在一项单中心前瞻性登记研究中评估了接受血管内治疗的前循环大血管闭塞患者。我们收集了临床和影像学数据。使用经过验证的自动化软件（英国牛津Brainomix有限公司）根据基线单相CT血管造影生成侧支循环评分（CS）：0分，闭塞的大脑中动脉区域充盈≤10%；1分，11%-50%；2分，51%-90%；3分，>90%。二分法分析时，我们认为CS良好（CS=2-3）或较差（CS=0-1）。我们进行了双变量和多变量有序逻辑回归分析，以预测我们研究人群中的CS类别。次要结果是确定自动化CS对3个月时功能结局的影响。我们将3个月时良好的功能结局定义为改良Rankin量表（mRS）评分为0-2分。
我们纳入了101例患者，平均年龄为72.1±13.1岁，其中57例（56.4%）为女性。根据CS将患者分为4组：7例（6.9%）CS=0分，15例（14.9%）CS=1分，43例（42.6%）CS=2分，36例（35.6%）CS=3分。入院收缩压[每升高10 mmHg的调整后比值比（aOR）为0.79（95%置信区间0.68-0.92）]和更高的基线美国国立卫生研究院卒中量表（NIHSS）评分[aOR为0.90（95%置信区间0.84-0.96）]与较差的CS相关。3个月时mRS评分提高1分的OR为1.63（95%置信区间1.10-2.44），提示CS较好（P=0.016）。
在接受血管内治疗的前循环大血管闭塞急性缺血性卒中患者中，入院收缩压与基线CT血管造影的CS自动评分呈负相关。此外，良好的CS与良好的结局相关。
