【作者】 刘亚东；

【导师】 鄂亚军；

【作者基本信息】 河北大学 ， 肿瘤学， 2018， 硕士

【摘要】 背景和目的:急性大血管闭塞性脑卒中动脉内机械取栓治疗明显提高了血管再通率,但即使在治疗时间窗内并不是所有成功再通患者都可以获得良好的临床预后。越来越多的研究显示时间窗并不是每一位患者的治疗窗口,不良预后可能与较差的侧支循环相关。本研究拟通过对治疗时间窗内成功开通的前循环大血管闭塞患者的影像学及临床资料进行分析,探讨大血管闭塞后侧支循环状态与患者预后的相关性。方法:回顾性分析2015年9月至2017年12月期间本院收治的61例急性前循环大血管闭塞患者的影像学及临床资料。根据侧支循环状态,使用美国神经介入放射学会侧支循环评分系统(American Society of Interventional and Therapeutic Neuroradiology/S ociety of Interventional Radiology,ASITN/SIR),将患者分为侧支循环较差组(0-2级)和良好组(3-4级),比较大血管急性闭塞后侧支循环状态与血管开通后90天临床结局、症状性颅内出血发生率及死亡率之间的关系。结果:所有患者平均年龄64.45±11.6岁,入院美国国立卫生研究院卒中量表评分(N ational Institute of Health stroke scale,NIHSS)中位数17(四分位数间距13-21)。在平均4.2(±3.2)个月的随访期内,90天mRS评分(modified Rankin Scale,m RS)组间比较,两组患者出院NIHSS评分及两组患者出院NIHSS评分较入院下降值的组间比较均显示侧支循环状态与患者预后具有显著相关性(P<0.05)。与良好侧支循环相比,侧支循环评分较低组患者的死亡率明显增高(13.63%比0%,P<0.05)。结论:治疗时间窗内成功开通的前循环大血管闭塞患者侧支循环状态在一定程度上决定了患者的预后,较差的侧支循环与开通术后症状性颅内出血及死亡事件发生密切相关。更多还原

【Abstract】 Background and purpose: Although intra-arterial therapy for acute ischemic stroke is associated with superior recanalization rates,improved clinical outcomes are inconsistently observed following successful recanalization.There is emerging concern that unfavorable arterial collateralization,though unproven,predetermines poor outcome.We hypothesized that poor leptomeningeal collateralization,assessed by preprocedural DSA,is associated with poor outcome in patients with acute ischemic stroke undergoing intra-arterial therapy.Material and methods: Retrospective analysis of 61 patients treated in authors’ hospital during September 2015 to December 2017 from a prospective thrombectomy registry.Collateral status on DSA source images was categorized into good(3-4)and poor(0-2)with the ASITN/SIR scores.The association will be analysed between DSA collateral status and successful recanalization,favourable clinical outcome at 3-months(mRS 0-2)mortality and intracranial hemorrhages at follow-up.Results: The mean age of all the patients was 64.45±11.6 years and baseline median NIHSS score was 17(IQR 13-21).Patients with poor collateral status had a significant higher mortality compared with good collaterals during a mean follow-up period of 4.2(±3.2)months(13.63% and 0%,P<0.05).Analysis showed a significant association between good collateral status and the good functional outcome at 3-months.Conclusions: We found that good collateral status was associated with good outcome,after adjustment for recanalization success.The poor collateral status were independent predictors of death and higher rate of intracranial hemorrhages.更多还原