|
|
|
| Collateral score based on CT perfusion can predict the prognosis of patients with anterior circulation ischemic stroke after thrombectomy |
| WANG Qingsong1,2, ZHANG Sheng1, ZHANG Meixia1, CHEN Zhicai1, LOU Min1 |
1. Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
2. Department of Neurology, Shengzhou People's Hospital, Shengzhou 312400, China |
|
|
|
Abstract Objective:To evaluate the value of collateral score based on CT perfusion (CTP-CS) in predicting the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy. Methods:Clinical data of acute ischemic stroke patients with anterior artery occlusion undergoing endovascular treatment in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and October 2016 were retrospectively reviewed. Collateral scores were assessed based on CTP and digital subtraction angiography (DSA) images, respectively. And DSA-CS or CTP-CS 3-4 was defined as good collateral vessels. Good clinical outcome was defined as a modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke. The binary logistic regression model was used to analyze the correlation between the collateral score and clinical outcome, and the receiver operating characteristic (ROC) curve was used to analyze the value of DSA-CS and CTP-CS in predicting the clinical outcome. Results:Among 40 patients, 33 (82.5%) acquired recanalization and 16 (40.0%) got good outcome. Compared with poor outcome group, the collateral score (all P<0.05) and the rate of good collateral vessels were higher in good outcome group (all P<0.01). After adjust baseline National Institute of Health Stroke Scale (NIHSS) and onset to recanalization time (ORT), good collateral vessels were independent factor of good outcome (CTP-CS:OR=48.404, 95% CI:1.373-1706.585, P<0.05; DSA-CS:OR=34.651, 95% CI:1.147-1047.018, P<0.05). Collateral scores based on CTP and DSA had good consistency (κ=0.697, P<0.01), and ROC curve showed that the predictive value of CTP-CS and DSA-CS were comparable (both AUC=0.726, 95%CI:0.559-0.893, P<0.05). Conclusion:CTP-CS can predict the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy.
|
|
Received: 10 February 2017
Published: 25 August 2017
|
|
|
基于CT灌注成像的侧支评分预测急性前循环大血管闭塞患者动脉取栓治疗预后的价值
目的：评估基于CT灌注成像的软脑膜侧支评价方法（CTP-CS）在预测急性前循环大血管闭塞患者动脉取栓治疗预后中的价值。方法：回顾性分析2013年10月至2016年10月浙江大学医学院附属第二医院急性前循环大血管闭塞动脉取栓患者的临床及影像学资料。采用CTP-CS和基于数字减影血管造影的侧支评分（DSA-CS）对侧支进行评分，DSA-CS或CTP-CS评分3~4分定义为侧支良好。预后优定义为术后3个月时改良Rankin量表（mRS）为2分及以下。采用二元logistic回归法分析侧支循环与患者预后的关系并用受试者工作特征（ROC）曲线评价DSA-CS和CTP-CS在预测患者预后中的价值。结果：共纳入40例患者，其中获得血管再通33例（82.5%），临床预后优16例（40.0%）。与预后不优的患者比较，预后优的患者侧支评分更高（均P<0.05），侧支良好比例更高（均P<0.01）。二元logistic回归分析提示，侧支评分是预后优的独立预测因素（CTP-CS：OR=48.404，95%CI：1.373~1706.585，P<0.05；DSA-CS：OR=34.651，95%CI：1.147~1047.018，P<0.05）。一致性分析提示，CTP-CS和DSA-CS两种评分间的一致性良好（κ=0.697，P<0.01）。ROC曲线分析结果显示，CTP-CS预测患者临床预后的能力与DSA-CS相当（均AUC=0.726，95%CI：0.559~0.893，P<0.05）。结论：CTP-CS评分能独立预测急性前循环大血管闭塞患者动脉取栓治疗的预后。
关键词：
急性病,
脑缺血/放射摄影术,
体层摄影术,
X线计算机/方法,
脑缺血/治疗,
卒中/治疗,
血栓溶解疗法/方法,
侧支循环,
预后
|
|
| [1] SCHRAMM P, SCHELLINGER P D, FIEBACH J B, et al. Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset[J]. Stroke,2002,33(10):2426-2432.
[2] SOUZA L C S, YOO A J, CHAUDHRY Z A, et al. Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke[J]. AJNR Am J Neuroradiol,2012,33(7):1331-1336.
[3] BANG O Y, SAVER J L, KIM S J, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke[J]. Stroke,2011,42(3):693-699.
[4] CHRISTOFORIDIS G A, MOHAMMAD Y, KEHAGIAS D, et al. Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke[J]. AJNR Am J Neuroradiol,2005,26(7):1789-1797.
[5] HIGASHIDA R T, FURLAN A J, ROBERTS H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke[J]. Stroke,2003,34(8):e109-e137.
[6] MORTIMER A M, SIMPSON E, BRADLEY M D, et al. Computed tomography angiography in hyperacute ischemic stroke:prognostic implications and role in decision-making[J]. Stroke,2013,44(5):1480-1488.
[7] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153. Cerebrovascular Disease Study Group, Chinese Medical Association Branch of Neurology. Chinese guidelines for acute ischemic stroke treatment 2010[J]. Chinese Journal of Neurology,2010,43(2):146-153. (in Chinese)
[8] CAMPBELL B C, MITCHELL P J, KLEINIG T J, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med,2015,372(11):1009-1018.
[9] MENON B K, D'ESTERRE C D, QAZI E M,et al. Multiphase CT angiography:a new tool for the imaging triage of patients with acute ischemic stroke[J]. Radiology,2015,275(2):510-520.
[10] ZAIDAT O O, YOO A J, KHATRI P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke:a consensus statement[J]. Stroke,2013,44(9):2650-2663.
[11] ERIKSSON M,NORRVING B,TERÉNT A, et al. Functional outcome 3 months after stroke predicts long-term survival[J]. Cerebrovasc Dis,2008,25(5):423-429.
[12] BANG O Y, SAVER J L, KIM S J, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke[J]. Stroke,2011,42(3):693-699.
[13] LAU A Y, WONG E H, WONG A, et al. Significance of good collateral compensation in symptomatic intracranial atherosclerosis[J]. Cerebrovasc Dis,2012,33(6):517-524.
[14] KIM S J, NOH H J, YOON C W, et al. Multiphasic perfusion computed tomography as a predictor of collateral flow in acute ischemic stroke:comparison with digital subtraction angiography[J]. Eur Neurol,2012,67:252-255. |
|
Viewed |
|
|
|
Full text
|
|
|
|
|
Abstract
|
|
|
|
|
Cited |
|
|
|
|
| |
Shared |
|
|
|
|
| |
Discussed |
|
|
|
|
