老年人大脑前循环急性大血管闭塞性缺血性卒中的临床结局

Clinical Outcome of Acute Ischemic Stroke with Large Vessel Occlusion of Cerebral Anterior Circulation in the Elderly

目的研究老年人大脑前循环急性大血管闭塞性缺血性卒中经过卒中中心诊疗后的临床结局,评估侧枝循环对患者临床结局的影响。方法连续纳入并分析近1年接受颅颈部CTA及DSA检查并诊断为由于颈内动脉(ICA)或大脑中动脉M1或M2段血管闭塞导致的急性缺血性卒中的老年患者。侧枝循环的状况分别在CTA、DSA检查上分级。患者的临床结局通过出院时的改良Rankin量表(mRS)评分来分为良好或差。卡方检验计算DSA上侧枝循环与患者出院时临床结局的相关性。结果共纳入了21的例老年患者。中位年龄为71岁(61~89岁)。在21例患者中,有7例患者出院时临床结局为良好(mRS≤3)。而在入院时基线NIHSS评分为15分及以上的10例患者中只有1例患者出院时的临床结局为良好。在DSA上显示侧枝循环良好的患者临床结局良好率高于侧枝循环差的患者(χ^2=5.25,P=0.022)。结论老年人大脑前循环急性大血管闭塞性缺血性卒中总体临床预后不良;特别是基线NIHSS评分高、侧枝循环差预示临床结局危重。

Objective To investigate the clinical outcome of acute ischemic stroke with large vessel occlusion of cerebral anterior circulation in the elderly and to explore the impact of collateral circulation on it.Methods Collection and analysis were made to the data of the elderly with acute ischemic stroke due to vessel occlusion of internal carotid artery (ICA) or of the middle cerebral artery M1/M2 segment diagnosed by CTA and DSA on the cranium and the nucha during the period from July 2017 to June 2018;grading of collateral circulation was made by CTAand DSA;the scores of reformed mRS at discharge were applied in evaluating the clinical outcome of the elderly while the correlation between collateral circulation on DSA and the clinical outcome at discharge was studied by Chi-square test.Results In total 21 elderly were enrolled;the media age was 71 years (61 to 89 years);out of the 21 cases,7 cases were of good outcome at discharge (mRS≤3);only 1 case out the 10 cases with baseline NIHSS score of 15 at admission was of good clinical outcome at discharge;DSA showed that the rate of good clinical outcome in cases with good collateral circulation were was higher than that in cases with poor collateral circulation (χ^2=5.25,P=0.022).Conclusions The elderly with acute ischemic stroke with large vessel occlusion of cerebral anterior circulation are usually of poor clinical outcome,the clinical outcome of those with high baseline NIHSS scores and poor collateral circulation are even poorer.