毛细血管指数评分预测急性前循环缺血性卒中血管内治疗预后的价值

目的使用毛细血管指数评分(CIS)判断急性前循环缺血性卒中患者侧支循环情况,评价血管内治疗预后。方法回顾性连续纳入2013年1月至2015年12月就诊于包头市中心医院行血管内治疗的急性前循环缺血性卒中患者46例,血管内治疗前行全脑DSA完成CIS,根据改良Rankin量表(mRS)评分分为良好预后组21例(≤2分),不良预后组25例(3分)。单因素分析比较两组基线资料和临床资料,如年龄、性别、糖尿病史、治疗前收缩压、是否行静脉溶栓、发病至静脉溶栓时间、治疗前美国国立卫生研究院卒中量表(NIHSS)评分、Alberta卒中项目早期CT评分(ASPECTS)、毛细血管充盈、发病至血管再通时间、术后血管再通改良脑梗死溶栓试验(m TICI)分级]等,多因素Logistic回归分析CIS对预后结局的影响。结果良好预后组与不良预后组比较,两组在年龄、性别、糖尿病史、治疗前收缩压、是否行静脉溶栓、发病至静脉溶栓时间、机械取栓次数等方面差异无统计学意义(均P0.05),治疗前NIHSS(15±3)分比(19±4)分]、ASPECTS8(7,10)分比6(5,8)分]、毛细血管充盈良好85.7%(18/21,CIS 2~3分)比44.0%(11/25,CIS 0~1分)、发病至血管再通时间(363±42)min比(398±53)min]、术后血管再通100.0%(21/21)比68.0%(17/25)],差异均有统计学意义(均P0.05)。多因素Logistic回归分析结果显示,CIS(OR=8.600,95%CI:2.670~33.800)和m TICI分级(OR=5.720,95%CI:12.170~22.300)是血管内治疗预后的预测因素。结论 CIS可用于评价脑组织灌注情况,毛细血管充盈和血管再通良好与临床预后密切相关,在血管内治疗时增加CIS评价,可作为挽救缺血脑组织的参考指标。

Capillary index score for predicting the prognostic value of endovascular treatment of acute ischemic stroke

Objective To determine collateral circulation in patients with acute ischemic stroke using capillary index score (CIS)in order to evaluate the prognosis of endovascular treatment. Methods From January 2013 to December 2015,46 consecutive patients with acute ischemic stroke treated with endovascular treatment at the Department of Neurology,Central Hospital of Baotou were enrolled retrospectively. Angiography was performed before endovascular treatment in order to complete CIS score. The patients were divided into a good prognosis group (n = 21)and a poor prognosis group (n = 25)according to the modified Rankin scale (mRS)scores. Univariate analysis was used to compare the baseline data and the clinical data of the two groups,including age,sex,history of diabetes,pretreatment systolic blood pressure,conducting intravenous thrombolysis or not,time from ictus to intravenous thrombolysis,National Institutes of Health Stroke Scale (NIHSS)score,Alberta stroke program early CT score (ASPECTS),vascular filling,time from onset to revascularization,and postoperative vascular recanalization (the modified Thrombolysis in Cerebral Infarction mTICI]). Multivariate analysis was used to analyze the effect of CIS score on good prognosis. Results There were no significant differences in age,sex,history of diabetes,pretreatment systolic blood pressure,conducting intravenous thrombolysis or not,time from ictus to thrombolysis,and number of mechanical thrombectomy between the good prognosis group and the poor prognosis group (all P > 0. 05). There were significant differences in the NIHSS score (15 ± 3 vs. 19 ± 4),ASPECTS score (8 7,10]vs. 6 5,8]),filling well 85. 7% (18 / 21)vs. 44. 0% 11 / 25]),time from ictus to recanalization (363 ± 42 min vs. 398 ± 53 min),and postoperative vascular recanalization (mTICI≥Ⅱb)(100. 0% 21 / 21]vs. 68. 0%17 / 25];all P < 0. 05). CIS (OR,8. 600,95% CI 2. 670 -33. 800)and mTICI grade (OR,5. 720, 95%CI 12. 170-22. 300)were significantly associated with the prognosis. Conclusion The CIS score can be used to evaluate brain perfusion. fCIS is closely associated with the good clinical prognosis. When screening the suitable patients for endovascular therapy,increasing the CIS score to evaluate the salvageable brain tissue is effective and feasible.