多模式血管影像在急性大脑中动脉闭塞性缺血性脑卒中侧支循环评估中的价值及对预后的影响

目的探究多模式血管影像在急性大脑中动脉(MCA)闭塞性缺血性脑卒中(AIS)侧支循环评估中的价值以及患者脑侧支循环状态对预后的影响。方法选取贵州医科大学第二附属医院神经内科及首都医科大学宣武医院神经内科2018年9月至2019年12月接受治疗的MCA闭塞性AIS患者72例,所有患者均于入院1周内行经颅彩色多普勒超声(TCCS)检查、计算机断层血管造影(CTA)检查。收集并记录患者临床资料。分析TCCS与CTA评估侧支循环的一致性以及Alberta卒中项目早期CT评分(ASPECTS)、侧支循环评分(CCS)与美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分的相关性。采用受试者工作特征(ROC)曲线分析对预后的评估价值。结果 TCCS与CTA检测患者侧支循环结果一致的患者66例,TCCS与CTA检测患者侧支循环结果的一致性高(Kappa值=0.825,P <0.05);将66例患者根据脑侧支循环状态分为侧支循环良好组41例和侧支循环不良组25例,侧支循环良好组ASPECTS、CCS评分(7.18±1.24)分,(3.97±0.83)分]均高于侧支循环不良组(5.21±1.07)分,(1.74±0.72)分,P <0.05];侧支循环良好组治疗后7 d NIHSS评分、90 d mRS评分(4.61±2.94)分,(1.39±0.95)分]均低于侧支循环不良组(11.04±6.28)分,(3.17±1.24)分,P <0.05];ASPECTS评分与NIHSS、mRS评分均呈负相关(r=-0.724、-0.637,P <0.05),CCS评分均与NIHSS、mRS评分均呈负相关(r=-0.653、-0.619,P <0.05);ASPECTS、CCS评分联合评估预后的ROC曲线下面积、敏感度和特异度(0.831,83.2%,70.5%)均高于ASPECTS、CCS评分单独评估(0.659,70.6%,68.7%;0.676,72.8%,68.4%,P <0.05)。结论多模式血管影像可从血管形态学、血流动力学等多个方面对MCA闭塞性AIS患者脑侧支循环状态进行综合评估,有效提高MCA闭塞性AIS患者侧支循环评估准确率。脑侧支循环的建立对预后的改善有重要意义。

Value of multimodal angiography in collateral circulation assessment of acute ischemic stroke induced by middle cerebral artery occlusion and its influence on prognosis

Objective To explore the value of multimodal angiography in collateral circulation assessment of acute ischemic stroke( AIS) induced by middle cerebral artery( MCA) occlusion and the influence of collateral circulation state on prognosis. Methods 72 patients with MCA occlusion were selected from the Neurology Department of the Second Affiliated Hospital of Guizhou Medical University and the Neurology Department of Xuanwu Hospital of Capital Medical University from September 2018 to December 2019. All the patients underwent transcranial color-coded sonography( TCCS) examination and computed tomography angiography( CTA) examination within 1 week of admission. Clinical data of the patients were collected and recorded. The consistency of TCCS and CTA in evaluating collateral circulation,and the correlation of Alberta Stroke Program Early CT Score( ASPECTS),Collateral Circulation Score( CCS) with National Institutes of Health Stroke Scale( NIHSS) and the Modified Rankin Scale( mRS) were analyzed. The receiver operating characteristic( ROC) curve was used to analyze the evaluation value for the prognosis. Results 66 patients with TCCS and CTA detection had the same collateral circulation results. The TCCS and CTA detection results were highly consistent( Kappa value = 0. 825,P < 0. 05). 66 patients were further divided into 41 patients of good collateral circulation group and 25 patients of poor collateral circulation group according to the state of cerebral collateral circulation,and the ASPECTS and CCS of the good collateral circulation group ( 7. 18 ±1. 24) scores,( 3. 97 ± 0. 83) scores] were higher than those of the poor collateral circulation group( 5. 21 ± 1. 07) scores,( 1. 74 ± 0. 72) scores,P < 0. 05]. The NIHSS on 7 th day and mRS on 90 th day after treatment in the good collateral circulation group ( 4. 61 ± 2. 94) scores,( 1. 39 ± 0. 95)scores] were lower than those in the poor collateral circulation group( 11. 04 ± 6. 28) scores,( 3. 17 ±1. 24) scores,P < 0. 05]. ASPECTS was negatively correlated with NIHSS and mRS( r =-0. 724,-0. 637,P < 0. 05),CCS was also negatively correlated with NIHSS and mRS( r =-0. 653,-0. 619,P < 0. 05). The area under the ROC curve,sensitivity and specificity of the combined assessment of ASPECTS and CCS in the prognosis of the patients( 0. 831,83. 2%,70. 5%) were higher than those of ASPECTS or CCS alone( 0. 659,70. 6%,68. 7%;0. 676,72. 8%,68. 4%,P < 0. 05). Conclusions TCCS combined with CTA can comprehensively evaluate the status of collateral circulation in AIS patients with MCA occlusion from various aspects such as vascular morphology and hemodynamics,which can effectively improve the accuracy of collateral circulation assessment. The establishment of collateral circulation is of great significance to improve the prognosis of patients.