基于DSA评估毛细血管状态与缺血性卒中血管内治疗预后的相关性  

Evaluation of the correlation between capillary status and prognosis of ischemic stroke endovascular treatment based on Digital subtraction angiography

作　　者：江秉泽 张哲宇 金天宇 徐彬 JIANG Bingze;ZHANG Zheyu;JIN Tianyu(The Second Clinical College of Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学第二临床医学院,浙江杭州310053 [2]浙江中医药大学附属第二医院神经内科,浙江杭州310005

出　　处：《中风与神经疾病杂志》2021年第8期701-706,共6页Journal of Apoplexy and Nervous Diseases

摘　　要：目的研究基于全脑血管造影术评估毛细血管状态与急性前循环缺血性卒中血管内治疗疗效与预后的相关性,探讨侧支循环在再灌注治疗过程中的保护作用。方法回顾性分析2020年1月-2020年12月间发病24 h时以内的急性前循环大动脉闭塞患者。采用毛细血管指数评分(CIS)对缺血脑组织的责任血管区域进行侧支循环评估,并根据CTP灌注成像的核心梗死体积和术后1 w内头部MR的DWI影像结果,计算最终梗死体积和进展梗死体积,并随访患者临床预后及与远期功能恢复。结果(1)基线ASPECTS评分(OR=2.246,95%CI 1.084~6.328,P<0.05)、大脑中动脉M1或M2闭塞(OR=4.801,95%CI 2.047~11.261,P<0.001)是侧支循环的独立影响因素;(2)基线ASPECT评分(OR=6.476,95%CI 1.618~21.921,P<0.001)、侧支循环(OR=12.304,95%CI 5.035~28.348,P<0.01)及出院NIHSS评分(OR=0.637,95%CI 0.473~0.858,P<0.01)是取栓患者3个月预后的独立影响因素。结论基于DSA评估毛细血管状态对发病24 h内急性前循环大动脉闭塞取栓患者的进展梗死体积及临床预后有良好的预测作用,侧支循环结合发病时间窗有助于筛选可能在血管内治疗中获益的AIS患者。Objective The study is based on digital subtraction angiography to evaluate the capillary status and the correlation between the efficacy and prognosis of endovascular treatment of acute anterior circulation ischemic stroke,and to explore the protective effect of collateral circulation in the process of reperfusion therapy.Methods A retrospective analysis of patients with acute anterior circulation aortic occlusion within 24 hours of onset from January 2020 to December 2020.The capillary index score(CIS)was used to evaluate the collateral circulation of the responsible vascular area of the ischemic brain tissue,and the final infarct volume and the DWI image results of the head MRI within 1 week after the operation were calculated based on the core infarct volume of CTP perfusion imaging and Progress in infarct volume,and follow-up to evaluate the clinical prognosis and long-term functional recovery of patients.Results(1)Baseline ASPECTS score(OR=2.246,95%CI 1.084~6.328,P<0.05)middle cerebral artery M1 or M2 occlusion(OR=4.801,95%CI 2.047~11.261,P<0.001)is a collateral branch independent influencing factors of the cycle.(2)Baseline ASPECT score(OR=6.476,95%CI 1.618~21.921,P<0.001),collateral circulation(OR=12.304,95%CI 5.035~28.348,P<0.01)and discharge NIHSS score(OR=0.637,95%CI 0.473~0.858,P<0.01)is an independent factor influencing the 3-month prognosis of patients with thrombus removal.Conclusion Assessment of capillary status based on DSA has a good predictive effect on the progression of infarct volume and clinical prognosis of patients with acute anterior circulation aortic occlusion within 24 hours of onset.The combination of collateral circulation and onset time window can help to screen the possible gains in endovascular treatment.Benefit of AIS patients.

关 键 词：缺血性卒中 毛细血管指数评分 侧支循环 进展梗死体积 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]