颈动脉粥样硬化性大血管闭塞与心源性栓塞性大血管闭塞患者侧支循环及临床预后的比较研究

The study of collateral circulation and clinical prognosis in atherosclerotic versus cardioembolic cerebral large vessel occlusion

目的探究颈动脉粥样硬化性与心源性栓塞性大血管闭塞患者的侧支循环及临床预后的差异。方法纳入我院2014年1月-2020年11月因前循环大血管闭塞接受血管内治疗的患者318例,颈动脉粥样硬化性卒中132例,心源性栓塞卒中186例,比较颈动脉狭窄与心源性栓塞患者的侧支循环评分、改良的Rankin量表(mRS)评分和90 d死亡率。结果颈动脉粥样硬化性卒中较心源性栓塞性卒中患者,颈内动脉末端闭塞的发生率更高(P<0.001),有较低的卒中前mRS评分(P<0.001)。与心源性栓塞性卒中相比,颈动脉粥样硬化性卒中患者有更高的侧支循环评分(调整后的OR值1.63),较低的90 d中位mRS评分(调整后的OR值1.93)。结论与心源性栓塞性卒中相比,颈动脉粥样硬化性卒中患者有更好的侧支循环,90 d时的中位mRS也更好。

Objective To investigate the difference in collateral circulation and clinical prognosis between cervical carotid atherosclerosis and cardioembolism.Methods We enrolled 318 adult endovascular patients with acute ischemic stroke due to anterior circulation occlusion between January 2014 and November 2020.132 patients with cervical carotid atherosclerosis and 186 with cardioembolism were included.The collateral score,the modified Rankin Scale(mRS)score,mortality at 90 days between patients with carotid artery stenosis and patients with cardiogenic embolism was compared.Results Compared with stroke due to cardiac embolism,stroke due to carotid atherosclerosis had a higher incidence of the internal carotid artery end occlusion(P<0.001)and a higher collateral-circulation score(OR=1.63),a lower mRS scores before stroke(P<0.001),and a lower 90-day median MRS score(OR=1.93).Conclusion Compared with cardiogenic embolic stroke patients,carotid atherosclerotic stroke patients have better collateral circulation and slightly better median MRS at 90 days.