全脑血管造影未见血管阻塞的急性脑梗死患者的临床预后

目的:探讨起病1周内全脑血管造影(DSA)未见血管阻塞的急性脑梗死患者的临床预后。方法:急性脑梗死患者260例,在发病1周内完成全脑血管DSA和头颅CT、MRI检查,采用NI HSS量表评估入院时病情,改良Rankin量表(mRS)评估患者3个月时的预后,mRS≤2分视为预后良好,并对影响患者预后的危险因素进行多因素logistic回归分析。结果:260例患者中,发病1周内全脑血管DSA正常者96例(37%),其中头颅MRI显示有相应梗死灶93例(97%),发病1周内脑血管自然再通率为18%(46/260)。脑血管DSA未见血管阻塞的患者3个月时预后良好者67例(70%)。多因素logistic回归分析显示,入院时NI HSS评分OR=0.231(0.080～0.811),P=0.013]、是否为大面积脑梗死OR=0.171(0.062～0.725),P=0.006]显著影响患者3个月时的预后。结论:起病1周内急性脑梗死患者血管的再通率为18%,DSA检查显示无血管阻塞的患者为37%,其中70%的患者预后良好,入院时的病情及脑梗死面积是影响患者3个月预后的主要因素。

Clinical Outcome of Acute Ischemic Stroke Patients Without Visible Arterial Occlusion on Digital Subtraction Angiogram

Objective: To delineate the clinical outcome of acute ischemic stroke patients without visible arterial occlusion on digital subtraction angiograms(DSA) within one week of stroke onset.Methods: 260 patients with acute ischemic stroke were examined by DSA,brain CT and MRI scanning within one week after stroke.On admission National Institutes of Health Stroke Scale(NIHSS) scores and on discharge modified Rankin Scores(mRS) were assessed.Good outcome was defined as a mRS score less than 2.Multivariate logistic regression analysis was used to evaluate the relationship between stroke risk factors and clinical outcome of patients.Results: In the 260 patients,no arterial occlusion was observed in 96(37%) patients.The spontaneous recanalization rate was 18%.About 70%(67/96) of the patients had a favorable clinical outcome 3 months afterwards.Multivariate logistic regression analysis showed that the admission NIHSS scores OR=0.231(0.080～0.811),P=0.013] and the size of cerebral infarction OR=0.171(0.062～0.725),P=0.006] were stroke risk factors which significantly affected 3-month outcome in patients.Conclusion: The spontaneous recanalization rate was 18%.Approximately 70% patients with ischemic stroke without arterial occlusion on DSA(within 1 week onset) have a favorable clinical outcome and the outcome at 3 months were affected by the admission NIHSS scores and the size of cerebral infarction.