TCD动态监测软脑膜侧支循环状态评估急性缺血卒中患者预后的可行性分析

The analysis of feasibility to use the state of leptomeningeal collateral circulation monitored by TCD assessing the prognosis of patients with acute cerebral infarction

目的通过经颅多普勒超声(transcranial Doppler,TCD)动态监测大脑中动脉(middle cerebral artery,MCA) M1段慢性闭塞所致急性缺血性卒中患者病程中软脑膜侧支循环建立及动态变化情况,评价其对预后的影响。方法收集单侧MCA M1段慢性闭塞所致的急性缺血性卒中患者,分别于入院时、7 d、14 d、21 d、60 d、90 d行TCD检查,以不同软脑膜侧支存在状态分为FD(flow diversion,FD)阳性组及FD阴性组,同期行NIHSS评分,记录90 d mRS评分,比较不同FD存在状态患者预后。结果共纳入符合条件患者57例,FD阳性43例(75%),FD阴性14例(25%),病程中软脑膜侧支循环存在状态相对稳定。FD阳性组NIHSS评分低于FD阴性组(P <0. 05),90 d mRS评分优于FD阴性组(P <0. 05)。结论 CA慢性闭塞的急性缺血性卒中患者,病程中软脑膜侧支循环存在状态相对稳定,且具有良好的代偿作用,可显著改善患者近期及远期预后,降低卒中进展风险。TCD评价软脑膜侧支循环可作为此类患者预后评估的工具。

Objective To study the effects of the status and changes of leptomeningeal collateral circulation to prognosis of patients with acute cerebral infarction which MCA M1 segment arterial being occluded through transcranial doppler( TCD) monitored dynamically. Methods Patients with acute cerebral infarction which M1-segment of MCA being occluded were collected. TCD and NIHSS score were performed and assessed on admission,7 d,14 d,21 d,60 d and 90 d. Divided into FD-positiveand FD-negative group according to different status of leptomeningeal collateral circulation. The differences of recent and long-term prognosis were compared. Results A total of 57 cases were included,among them 43 cases were FD positive( 75%),14 cases were FD negative( 25%). During the course,the existence of FD being sustained stably. The prognosis of patients with FD positive were better than that of FD negative patients( P < 0. 05). Conclusion During the course of the patients with acute cerebral infarction caused by the occlusion of M1-segment MCA,the existing state of leptomeningeal collateral circulation being sustained stablely. Leptomeningeal collateral circulation had good compensatory effect to patients with acute cerebral infarction caused by the occlusion of M1-segment MCA. Its existence could improve the patients’ recent and long-term prognosis significantly and lower the progression risk of acute ischemic stroke.TCD was a favorable tool which could used to assess the prognosis of patients with acute cerebral infarction which MCA M1 segment arterial was occluded through monitoring the status of leptomeningeal collateral circulation.