急性脑梗死患者脑侧支循环形成情况及其对梗死体积和预后的影响
|
摘要
目的探讨急性脑梗死患者脑侧支循环形成情况及其对梗死体积和预后的影响。方法回顾分析352例住院治疗期间行头颈部256层螺旋CT血管造影(CTA)检查的急性脑梗死患者临床资料,依据头颈部CTA影像结果观察到的侧支循环形成情况,分为有侧支循环组和无侧支循环组,分析急性脑梗死患者脑侧支循环形成情况及其与梗死体积和预后的关系。结果 (1)352例急性脑梗死患者中,有侧支循环形成197例(56.0%),无侧支循环形成者155例(44.0%)。197例有侧支循环形成患者中,前交通动脉开放74例(37.6%),后交通动脉开放53例(26.9%),软脑膜侧支建立113例(57.4%),眼动脉开放9例(4.6%),枕动脉4例(2.0%),颈升动脉4例(2.0%)。(2)有侧支循环组急性脑梗死患者的梗死灶体积明显小于无侧支循环组(Z=-2.597,P=0.009),差异有统计学意义。(3)有侧支循环形成组急性脑梗死患者的预后明显好于无侧支循环形成组(Z=-3.541,P=0.000),差异有统计学意义。结论有脑侧支循环形成的急性脑梗死患者脑梗死体积小,预后较好。
Objective To investigate the formation of cerebral collateral circulation in patients with acute cerebral infarction and its effect on infarct volume and prognosis.Methods A retrospective analysis was performed on the clinical data of 352 cases of hospitalized head and neck256 slice spiral CT angiography(CTA)examination of patients with acute cerebral infarction.According to the formation of collateral circulation in the head CTA imaging results,it was divided into collateral circulation group and none collateral circulation group,to analysis of the formation of cerebral collateral circulation in patients with acute cerebral infarction and its relationship with infarct volume and prognosis.Results In 352 cases of acute cerebral infarction patients,197 cases(56.0%)were with collaterals,155 cases(44.0%)were with none collateral.In 197 cases with collaterals,the anterior communicating artery opening 74 cases(37.6%),the posterior communicating artery opening 53 cases(26.9%),collateral leptomeningeal establishing 113 cases(57.4%),ophthalmic artery opening 9 cases(4.6%),occipital artery opening 4 cases(2.0%),occipital artery opening 4 cases(2.0%).The volume of acute cerebral infarction in patients with collateral circulation was significantly smaller than that in patients without collateral circulation(Z=-2.597,P=0.009),the difference was statistically significant.The prognosis of acute cerebral infarction in patients with collateral circulation was significantly better than that in patients without collateral circulation(Z=-3.541,P=0.000),the difference was statistically significant.Conclusion The acute cerebral infarction in patients with collateral circulation has small infarct volume,the prognosis is better.
Objective To investigate the formation of cerebral collateral circulation in patients with acute cerebral infarction and its effect on infarct volume and prognosis.Methods A retrospective analysis was performed on the clinical data of 352 cases of hospitalized head and neck256 slice spiral CT angiography(CTA)examination of patients with acute cerebral infarction.According to the formation of collateral circulation in the head CTA imaging results,it was divided into collateral circulation group and none collateral circulation group,to analysis of the formation of cerebral collateral circulation in patients with acute cerebral infarction and its relationship with infarct volume and prognosis.Results In 352 cases of acute cerebral infarction patients,197 cases(56.0%)were with collaterals,155 cases(44.0%)were with none collateral.In 197 cases with collaterals,the anterior communicating artery opening 74 cases(37.6%),the posterior communicating artery opening 53 cases(26.9%),collateral leptomeningeal establishing 113 cases(57.4%),ophthalmic artery opening 9 cases(4.6%),occipital artery opening 4 cases(2.0%),occipital artery opening 4 cases(2.0%).The volume of acute cerebral infarction in patients with collateral circulation was significantly smaller than that in patients without collateral circulation(Z=-2.597,P=0.009),the difference was statistically significant.The prognosis of acute cerebral infarction in patients with collateral circulation was significantly better than that in patients without collateral circulation(Z=-3.541,P=0.000),the difference was statistically significant.Conclusion The acute cerebral infarction in patients with collateral circulation has small infarct volume,the prognosis is better.
引文
[1]刘斌,任伯,毛文静,等.急性脑梗死患者牛津郡社区卒中项目亚型脑侧支循环的形成及其对近期预后的影响[J].中国医药导报杂志,2017,14(11):64-68
[2]Yeo LLL,Paliwal P,Teoh HL,et al.Assessment of intracranial collaterals on CT angiography in anterior circulation acute ischemic stroke[J].American Journal of Neuroradiology.2015,36(2):289-294
[3]中华神经科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380
[4]Cortijo E,Calleja AI,García-Bermejo P,et al.Relative cerebral blood volume as a marker of durable tissue-at-risk viability in hyperacute ischemic stroke[J].Stroke,2014,45(1):113-118
[5]Pullicno P.Small deep infarcts dignosed on computed tomography[J].Neurology,1980,30:1890-1891
[6]刘蓉,朱江涛,龚建平,等.利用CTA的侧支循环评分预测大脑中动脉M1段闭塞后脑梗死体积及分布情况[J].放射学实践,2016,31(10):919-923
[7]中华神经科学会.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383
[8]黄家星,林文华,刘丽萍,等.缺血性卒中侧支循环评估与干预中国专家共识[J].中国卒中杂志,2013,8(4):285-293
[9]张晋霞,王旭,刘颖,等.脑梗死患者牛津郡社区脑卒中项目分型256层螺旋CT头颈部血管成像特点分析[J].中国动脉硬化杂志2015,23(7):689-692
[10]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
[11]Saito I,Segawa H,Shiokawa Y,et al.Middle cerebral artery occlusion:correlation of computed tomography andangiography with clinical outcome[J].Stroke,1987,18(5):863-868
[12]孙勇,李莹,魏微,等.CT血管成像的侧支循环评分用于预测急性脑梗死患者的最终梗死体积[J].中华老年心脑血管病杂志,2013,15(12):1265-1268
[13]Bang OY,Saver JL,Kim SJ,et al.Collateral flow predicts response to endovascular therapy for acute ischemic stroke[J].Stroke,2011,42(3):693-699
[14]Lima FO,Furie KL,Silva GS,et al.The Pattern of Leptomeningeal Collaterals on CT Angiography is a Strong Predictor of Long-Term Functional Outcome in Stroke Patients with Large Vessel Intracranial Occlusion[J].Stroke,2010,41(10):2316-2322
[15]孙勇,魏微,李莹,等.CTA-MIP对急性大脑中动脉闭塞脑梗死侧支循环及预后的评估[J].中风与神经疾病杂志,2014,31(3):196-199
[16]吴竹青,汪国宏,王小强,等.单侧颈内动脉重度狭窄或闭塞患者侧支循环与临床预后的关系[J].中华老年心脑血管病杂志,2015,17(5):463-465
[2]Yeo LLL,Paliwal P,Teoh HL,et al.Assessment of intracranial collaterals on CT angiography in anterior circulation acute ischemic stroke[J].American Journal of Neuroradiology.2015,36(2):289-294
[3]中华神经科学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380
[4]Cortijo E,Calleja AI,García-Bermejo P,et al.Relative cerebral blood volume as a marker of durable tissue-at-risk viability in hyperacute ischemic stroke[J].Stroke,2014,45(1):113-118
[5]Pullicno P.Small deep infarcts dignosed on computed tomography[J].Neurology,1980,30:1890-1891
[6]刘蓉,朱江涛,龚建平,等.利用CTA的侧支循环评分预测大脑中动脉M1段闭塞后脑梗死体积及分布情况[J].放射学实践,2016,31(10):919-923
[7]中华神经科学会.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383
[8]黄家星,林文华,刘丽萍,等.缺血性卒中侧支循环评估与干预中国专家共识[J].中国卒中杂志,2013,8(4):285-293
[9]张晋霞,王旭,刘颖,等.脑梗死患者牛津郡社区脑卒中项目分型256层螺旋CT头颈部血管成像特点分析[J].中国动脉硬化杂志2015,23(7):689-692
[10]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
[11]Saito I,Segawa H,Shiokawa Y,et al.Middle cerebral artery occlusion:correlation of computed tomography andangiography with clinical outcome[J].Stroke,1987,18(5):863-868
[12]孙勇,李莹,魏微,等.CT血管成像的侧支循环评分用于预测急性脑梗死患者的最终梗死体积[J].中华老年心脑血管病杂志,2013,15(12):1265-1268
[13]Bang OY,Saver JL,Kim SJ,et al.Collateral flow predicts response to endovascular therapy for acute ischemic stroke[J].Stroke,2011,42(3):693-699
[14]Lima FO,Furie KL,Silva GS,et al.The Pattern of Leptomeningeal Collaterals on CT Angiography is a Strong Predictor of Long-Term Functional Outcome in Stroke Patients with Large Vessel Intracranial Occlusion[J].Stroke,2010,41(10):2316-2322
[15]孙勇,魏微,李莹,等.CTA-MIP对急性大脑中动脉闭塞脑梗死侧支循环及预后的评估[J].中风与神经疾病杂志,2014,31(3):196-199
[16]吴竹青,汪国宏,王小强,等.单侧颈内动脉重度狭窄或闭塞患者侧支循环与临床预后的关系[J].中华老年心脑血管病杂志,2015,17(5):463-465