侧支循环对急性大脑中动脉闭塞血管内治疗预后的影响

Effect of collateral circulation on prognosis of endovascular treatment for acute middle cerebral artery occlusion

目的探讨侧支循环对急性大脑中动脉闭塞患者经血管内治疗后预后的影响。方法收集急性大脑中动脉近端(M1)闭塞并行血管内治疗的患者32例。采用美国介入与治疗神经放射学学会和介入放射学学会(ASITN/SIR)基于数字剪影血管造影(DSA)的侧支代偿分级标准(ACG),将ACG为2~3级者,以侧支代偿供血是否大于闭塞血管供血区50%为界限分为2组,回顾性分析观察2组患者的临床预后。结果2组患者在卒中高危因素、NIHSS评分、闭塞血管开通、术后即刻CT高密度渗出、早期出血转化方面差异无统计学意义;侧支循环代偿供血≥闭塞血管供血区50%组的患者,90 d临床预后良好率72.73%,显著高于对照组的30.00%(P<0.05)。结论侧支循环与急性大脑中动脉闭塞行血管内治疗患者的临床预后密切相关,基于DSA的侧支循环评估对血管内治疗预后的判断有重要意义。

Objective To investigate the effect of collateral circulation on the prognosis for patients with acute middle cerebral artery occlusion after the endovascular treatment.Methods 32 patients with acute proximal middle cerebral artery occlusion(M1)were treated by endovascular therapy.The Collateral compensation grading scale(ACG)based on digital Silhouette angiography(DSA)of the American Society of Interventional and Neuroradiology and the Society of Interventional Radiology(ASITN/SIR)was used.The patients with grade 2-3 ACG were divided into two groups according to whether the collateral compensatory blood supply was 50%larger than the occlusion blood supply area.Retrospective analysis was performed to observe the clinical prognosis of patients in the two groups.Results There were no significant differences between the two groups in risk factors of stroke,NIHSS score,occlusion vessel opening,CT high-density exudation immediately after surgery and early hemorrhage transformation.The proportion of patients with compensatory collateral circulation≥occluded blood supply area by 50%was significantly higher than that in the control group on the good clinical prognosis rate at 90 days(P<0.05).Conclusion Collateral circulation is associated with clinical prognosis of patients undergoing endovascular therapy for acute middle cerebral artery occlusion.Evaluation of collateral circulation based on DSA is of great significance for the prognosis of endovascular therapy.