基于多模CT的区域软脑膜侧支循环评估在血管再通预测中的应用价值分析

Value of regional leptomeningeal collateral circulation scale based on multi-mode CT in predicting recanalization of blood vessels after thrombectomy

目的探讨基于多模CT的区域软脑膜侧支循环(rLMC)评分对急性缺血性脑卒中患者取栓治疗后血管再通的预测价值。方法回顾性分析自2017年10月至2019年12月德阳市人民医院收治的首次发病6 h内的急性缺血性脑卒中患者80例,所有患者均采用颅脑CT排除出血性病变并行取栓治疗。将患者评估区域分为2个部分:大脑前动脉(ACA)-大脑中动脉(MCA)区和大脑后动脉(PCA)-MCA区,计算2个区域的rLMC总分(0~10分),0~3分为rLMC较差,4~7分为rLMC中等,8~10分为rLMC较好。患者入院后在时间窗内完成取栓治疗并即刻采用脑梗死溶栓(TICI)分级评估取栓治疗后血流再通情况,TICI分级≥Ⅱ级为血管再通成功。评估rLMC与急性缺血性脑卒中患者血管再通的相关性。结果80例患者中rLMC较差组患者17例,rLMC中等组患者25例,rLMC较好组患者38例。血管再通成功68例(85.00%),rLMC较好组患者血管再通成功率明显高于rLMC较差组(97.36%vs.58.82%),差异有统计学意义(P<0.05)。相关分析结果显示,rLMC与血管再通成功率呈正相关关系(rs=0.625,P=0.000)。其预判血管再通的敏感性为89.5%,特异性为90.9%,阳性预测值为94.45%,阴性预测值为83.3%,准确性为90.0%。结论rLMC与急性缺血性脑卒中取栓治疗后血管再通成功率密切相关,较好的侧支循环状态下行血管内治疗后血管再通成功率较高。

Objective To explore the predictive value of regional leptomeningeal collateral circulation scale(rLMC)based on multimodal CT in recanalization of blood vessels in patients with acute ischemic stroke after thrombectomy.Methods A retrospective analysis was conducted on clinical data of patients with acute ischemic stroke within 6 h of first onset,admitted to our hospital from October 2017 to December 2019.Before operation,the conditions of their vessels were evaluated by rLMC based on multimodal CT.Two areas,anterior cerebral artery(ACA)-middle cerebral artery(MCA)area and posterior cerebral artery(PCA)-MCA area,were divided.The total rLMC scores of two areas(0-10)were calculated:scores of 0-3,scores of 4-7,scores of 8-10.After admission,the recanalization of the blood vessels after thrombectomy was evaluated immediately according to grading of thrombolysis in cerebral infarction(TICI)after completion of thrombectomy within the time window;TICI grading≥II was defined as succeed recanalization.The correlation between rLMC scores and vascular recanalization in patients with acute ischemic stroke was evaluated.Results Among the 80 patients,17 were in the rLMC scores of 0-3 group,25 in the group of rLMC scores of 4-7,and 38 in the group of rLMC scores of 8-10;68 patients(85.00%)had vascular recanalization,and the success rate of vascular recanalization in patients from the group of rLMC scores of 8-10 was significantly higher than that in the group of rLMC scores of 0-3(97.36%vs.58.82%,P<0.05).Correlation analysis results showed that the rLMC score was positively correlated with success rate of vascular recanalization(rs=0.625,P=0.000);whose sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 89.5%,90.9%,94.45%,83.3%and 90.0%,respectively.Conclusion The rLMC is closely related to the recanalization rate in patients with acute ischemic stroke after thrombectomy;the success rate of recanalization after intravascular treatment is relatively high in patients with rLMC scores of 8-10.