TCD动态监测软脑膜侧支循环状态评估急性缺血卒中患者预后的可行性分析
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摘要
目的通过经颅多普勒超声(transcranial Doppler,TCD)动态监测大脑中动脉(middle cerebral artery,MCA) M1段慢性闭塞所致急性缺血性卒中患者病程中软脑膜侧支循环建立及动态变化情况,评价其对预后的影响。方法收集单侧MCA M1段慢性闭塞所致的急性缺血性卒中患者,分别于入院时、7 d、14 d、21 d、60 d、90 d行TCD检查,以不同软脑膜侧支存在状态分为FD(flow diversion,FD)阳性组及FD阴性组,同期行NIHSS评分,记录90 d mRS评分,比较不同FD存在状态患者预后。结果共纳入符合条件患者57例,FD阳性43例(75%),FD阴性14例(25%),病程中软脑膜侧支循环存在状态相对稳定。FD阳性组NIHSS评分低于FD阴性组(P <0. 05),90 d mRS评分优于FD阴性组(P <0. 05)。结论 CA慢性闭塞的急性缺血性卒中患者,病程中软脑膜侧支循环存在状态相对稳定,且具有良好的代偿作用,可显著改善患者近期及远期预后,降低卒中进展风险。TCD评价软脑膜侧支循环可作为此类患者预后评估的工具。
Objective To study the effects of the status and changes of leptomeningeal collateral circulation to prognosis of patients with acute cerebral infarction which MCA M1 segment arterial being occluded through transcranial doppler( TCD) monitored dynamically. Methods Patients with acute cerebral infarction which M1-segment of MCA being occluded were collected. TCD and NIHSS score were performed and assessed on admission,7 d,14 d,21 d,60 d and 90 d. Divided into FD-positiveand FD-negative group according to different status of leptomeningeal collateral circulation. The differences of recent and long-term prognosis were compared. Results A total of 57 cases were included,among them 43 cases were FD positive( 75%),14 cases were FD negative( 25%). During the course,the existence of FD being sustained stably. The prognosis of patients with FD positive were better than that of FD negative patients( P < 0. 05). Conclusion During the course of the patients with acute cerebral infarction caused by the occlusion of M1-segment MCA,the existing state of leptomeningeal collateral circulation being sustained stablely. Leptomeningeal collateral circulation had good compensatory effect to patients with acute cerebral infarction caused by the occlusion of M1-segment MCA. Its existence could improve the patients' recent and long-term prognosis significantly and lower the progression risk of acute ischemic stroke.TCD was a favorable tool which could used to assess the prognosis of patients with acute cerebral infarction which MCA M1 segment arterial was occluded through monitoring the status of leptomeningeal collateral circulation.
Objective To study the effects of the status and changes of leptomeningeal collateral circulation to prognosis of patients with acute cerebral infarction which MCA M1 segment arterial being occluded through transcranial doppler( TCD) monitored dynamically. Methods Patients with acute cerebral infarction which M1-segment of MCA being occluded were collected. TCD and NIHSS score were performed and assessed on admission,7 d,14 d,21 d,60 d and 90 d. Divided into FD-positiveand FD-negative group according to different status of leptomeningeal collateral circulation. The differences of recent and long-term prognosis were compared. Results A total of 57 cases were included,among them 43 cases were FD positive( 75%),14 cases were FD negative( 25%). During the course,the existence of FD being sustained stably. The prognosis of patients with FD positive were better than that of FD negative patients( P < 0. 05). Conclusion During the course of the patients with acute cerebral infarction caused by the occlusion of M1-segment MCA,the existing state of leptomeningeal collateral circulation being sustained stablely. Leptomeningeal collateral circulation had good compensatory effect to patients with acute cerebral infarction caused by the occlusion of M1-segment MCA. Its existence could improve the patients' recent and long-term prognosis significantly and lower the progression risk of acute ischemic stroke.TCD was a favorable tool which could used to assess the prognosis of patients with acute cerebral infarction which MCA M1 segment arterial was occluded through monitoring the status of leptomeningeal collateral circulation.
引文
[1]Liebeskind DS,Ma GAC,Saver JL,et al. Collaterals dramatically alter stroke risk in intracranial atherosclerosis[J]. Ann Neurol,2011,69(6):963-974.
[2]中国卒中学会脑血流与代谢分会.缺血性卒中脑侧支循环评估与干预中国指南(2017)[J].中华内科杂志,2017,56(6):460-471
[3]高山,黄家星.经颅多普勒超声(TCD)的诊断技术与临床应用[M].北京:中国协和医科大学出版社,2004. 54-58.
[4]Jauch EC,Saver JL,Adams HP,et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Hert Association/American Stroke. Association[J]. Stroke,2013,44(3):870-947.
[5]Kalowska E,Rostrup E,Rosenbaum S,et al. Acute MRI changes in progressive ischem in stroke[J]. Eur Neurol,2008,59(5):229-236.
[6]Ringelstein EB,Biniek R,Weiller C,et al. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization[J]. Neurology,1992,42(2):289-298.
[7]Bang OY,Saver JL,Buck BH,et al. Impact of collatera flow on tissue fate in acute ischaemic stroke[J]. J Neurol Neurosurg Psychiatry,2008,79(6):625-629.
[8]Shuaib A,Butcher K,Mohammad A,et al. Collateral blood vessels in acute ischaemic stroke:a potential therapeutic target[J]. Lancet Neurology,2011,10(10):909-921.
[9]Tsivgoulis G,Sharma VA,Malkoff M,et al. Validation of transcranial Doppler with computed tomography angiography in acute cerebral ischemia[J]. Stroke,2007,38(4):1245-1249.
[10]Welschehold S,Boor S,Reuland K,et al. Technical aids in the diagnosis of brain death:a comparison of SEP,AEP,EEG,TCD and CT angiography. Dtsch Arztebl Int[J]. Dtsch Arztebl,2012,109(39):624-630.
[11]Kim YS,Meyer JS,Garami Z,et al. Flow diversion in transcranial Doppler ultrasound is associated with better improvement in patients with acute middle cerebral artery occlusion[J]. Cerebrovasc Dis,2006,21(1/2):74-78.
[12]Kim YS,Sin DS,Park HY,et al. Relationship between flow diversion on transcranial Doppler sonography and leptomeningeal collateral circulation in patients with middle cerebral artery occlusive disorder[J]. J Neuroimaging,2009,19(1):23-26.
[13]Liebeskind DS,Cotsonis GA,Saver JL,et al. Collateral dramatically alter stroke risk in intracranial astherosclerosis[J]. Ann Neurol,2011,69(6):963-974.
[14]Miteff F,Levi CR,Bateman GA,et al. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke[J]. Brain,2009,132(8):2231-2238.
[15]Cho HJ,Yang JH,Jung YH,et al. Cortex-sparing infarctions in patients with occlusion of the middle cerebral artery[J]. J Neurol Neurosurg Psychiatry,2010,81(8):859-863.
[16]罗语嫣,郭鹏,丰宏林,等.大脑中动脉M1段闭塞患者软脑膜侧支循环与脑梗死体积及其分布的关系[J],中国脑血管病杂志,2012,9(2):77-81.
[17]Saarinen JT,Rusanen H. Collateral score complements clot location in predicting the outcome of intravenous thrombolysis[J]. AJNR Am J Neuroradiol,2014,35(10):1892-1896.
[18]贾革,陈秋惠,张海娜,等.进展性卒中相关危险因素分析[J].中国老年学杂志,2014,34(14):4110-4113.
[19]Maas MB,Lev MH,Ay H,et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke[J]. Stroke,2009,40(9):3001-3005.
[2]中国卒中学会脑血流与代谢分会.缺血性卒中脑侧支循环评估与干预中国指南(2017)[J].中华内科杂志,2017,56(6):460-471
[3]高山,黄家星.经颅多普勒超声(TCD)的诊断技术与临床应用[M].北京:中国协和医科大学出版社,2004. 54-58.
[4]Jauch EC,Saver JL,Adams HP,et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Hert Association/American Stroke. Association[J]. Stroke,2013,44(3):870-947.
[5]Kalowska E,Rostrup E,Rosenbaum S,et al. Acute MRI changes in progressive ischem in stroke[J]. Eur Neurol,2008,59(5):229-236.
[6]Ringelstein EB,Biniek R,Weiller C,et al. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization[J]. Neurology,1992,42(2):289-298.
[7]Bang OY,Saver JL,Buck BH,et al. Impact of collatera flow on tissue fate in acute ischaemic stroke[J]. J Neurol Neurosurg Psychiatry,2008,79(6):625-629.
[8]Shuaib A,Butcher K,Mohammad A,et al. Collateral blood vessels in acute ischaemic stroke:a potential therapeutic target[J]. Lancet Neurology,2011,10(10):909-921.
[9]Tsivgoulis G,Sharma VA,Malkoff M,et al. Validation of transcranial Doppler with computed tomography angiography in acute cerebral ischemia[J]. Stroke,2007,38(4):1245-1249.
[10]Welschehold S,Boor S,Reuland K,et al. Technical aids in the diagnosis of brain death:a comparison of SEP,AEP,EEG,TCD and CT angiography. Dtsch Arztebl Int[J]. Dtsch Arztebl,2012,109(39):624-630.
[11]Kim YS,Meyer JS,Garami Z,et al. Flow diversion in transcranial Doppler ultrasound is associated with better improvement in patients with acute middle cerebral artery occlusion[J]. Cerebrovasc Dis,2006,21(1/2):74-78.
[12]Kim YS,Sin DS,Park HY,et al. Relationship between flow diversion on transcranial Doppler sonography and leptomeningeal collateral circulation in patients with middle cerebral artery occlusive disorder[J]. J Neuroimaging,2009,19(1):23-26.
[13]Liebeskind DS,Cotsonis GA,Saver JL,et al. Collateral dramatically alter stroke risk in intracranial astherosclerosis[J]. Ann Neurol,2011,69(6):963-974.
[14]Miteff F,Levi CR,Bateman GA,et al. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke[J]. Brain,2009,132(8):2231-2238.
[15]Cho HJ,Yang JH,Jung YH,et al. Cortex-sparing infarctions in patients with occlusion of the middle cerebral artery[J]. J Neurol Neurosurg Psychiatry,2010,81(8):859-863.
[16]罗语嫣,郭鹏,丰宏林,等.大脑中动脉M1段闭塞患者软脑膜侧支循环与脑梗死体积及其分布的关系[J],中国脑血管病杂志,2012,9(2):77-81.
[17]Saarinen JT,Rusanen H. Collateral score complements clot location in predicting the outcome of intravenous thrombolysis[J]. AJNR Am J Neuroradiol,2014,35(10):1892-1896.
[18]贾革,陈秋惠,张海娜,等.进展性卒中相关危险因素分析[J].中国老年学杂志,2014,34(14):4110-4113.
[19]Maas MB,Lev MH,Ay H,et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke[J]. Stroke,2009,40(9):3001-3005.