目的:分析未能实现早期再灌注(early reperfusion,ER)的大脑中动脉(middle cerebral artery,MCA)M1段重度狭窄及闭塞的脑卒中患者侧支循环状态对长期预后的影响。

方法:连续纳入2017年9月至2019年8月的经计算机体层血管成像(computed tomography angiography,CTA)或计算机体层灌注(computed tomo-graphy perfusion,CTP)诊断为 MCA M1段重度狭窄及闭塞的且未能实现 ER 的患者 71 例,将其分为侧支循环良好组(42 例)及侧支循环不良组(29 例),采用 Logistic 回归分析进行统计分析。

结果:单因素分析显示侧支循环良好组基线美国国立卫生研究院脑卒中量表(NationalInstitutes of Health Stroke Scale,NIHSS )评分、首次改良 Rankin 量表(modified RankingScale,mRS)评分、发病后3个月时及6个月时的 mRS 评分均低于侧支循环不良组( P<0.05)。多因素分析显示侧支循环良好组患者3个月时的优异功能结局[(0≤mRS 评分≤1)，(比值比4.84,95%置信区间:1.28~18.22)、良好功能结局(0≤mRS 评分≤2),比值比:5.18,95%置信区间为 1.38~19.35)]和6个月时的优异功能结局(比值比:8.75,95%置信区间为 2.37~32.66)均较侧支循环不良组患者的比例高(P<0.05);侧支循环良好组患者脑卒中复发风险( 比值比:0.10,95%置信区间为 0.01~0.69)较侧支循环不良组患者低( P<0.05)。

结论:良好的侧支循环能够改善未能实现 ER 的 MCA 重度狭窄及闭塞患者长期的优异功能结局及降低卒中复发风险。

Objective: To analyze the influence of collateral circulation on long-term prognosis in strokep atients with severe stenosis and occlusion of M1 segment of middle cerebral artery (MCA) that failed to achieve early reperfusion (ER).

Methods: From September 2017 to August 2019, we recruited 71 patients with severe stenosis and occlusion on M1 segment of MCA diagnosed by CT angiography (CTA) or CT perfusion imaging (CTP) who failed to achieve ER were enrolled. They were divided into good collateral circulation group (42 cases) and poor collateral circulation group(29 cases) and the logistic regression analysis was used for statistical analysis.

Results: The National Institutes of Health Stroke Scale (NIHSS) score and the modifed Ranking Scale(mRS) score at 3 months and 6 months after the onset in the good collateral circulation group were all lower than those in the poor collateral circulation group(P<0.05)The multivariate analysis showed that the excellent functional outcome (0≤mRS score≤1;odds ratio:4.84,95% confidence interval: 1.28-18.22), good functional outcome(0≤mRS score<2; odds ratio: 5.18,95% confidence interval: 1.38-19.35)at 3 months and excellent functional outcome at 6 months(odds ratio: 8.75, 95% confidence interval: 2.37-32.66) in the good collateral circulation group were higher than those in the poor collateral circulation group(P<0.05). The risk of stroke recurrence in patients with good collateral circulation (odds ratio: 0.10,95% confidence interval: 0.01-0.69) was lower than that in patients with poor collateral circulation(P<0.05).

Conclusion: Good collateral circulation can improve the long-term excellent functional outcome and reduce the risk of stroke recurrence in patients with severe stenosis and occlusion of MCA who fail to achieve ER.