Digital subtraction angiography in predicting outcome of mechanical reperfusion therapy in patients with acute ischemic stroke: a preliminary analysis

医学 数字减影血管造影 闭塞 侧支循环 血管造影 神经组阅片室 内科学 缺血 再灌注治疗 分级比例尺 放射科 心脏病学 外科 神经学 精神科
作者
文婉玲,张永巍,杨志刚,黄清海,许奕,赵文元,刘建民,洪波
出处
期刊:Chin J Neurol 卷期号:48 (5): 373-376
标识
DOI:10.3760/cma.j.issn.1006-7876.2015.05.005
摘要

Objective To investigate the effectiveness of digital subtraction angiography (DSA) in predicting the clinical outcome of acute ischemic stroke patients who received mechanical reperfusion therapy due to large artery occlusion (LAO) in anterior circulation. Methods Collaterals of individuals were evaluated according to American Society of Interventional and Therapeutic Neuroradiology collateral grading system (ACG) based on DSA sequences acquired before any intra-arterial intervention. The relationship between baseline information and clinical outcome of patients with different ACG scores was retrospectively analyzed. Results Thirty-three cases were valid for analysis, with 12 having limited collaterals (ACG=0/1), 13 having moderate ones (ACG=2) and 8 abundant (ACG=3/4). The rate of independent living (mRS scores 0-2) in 3 groups at 3 months was 0/12, 6/13, 8/8 respectively, which increased with better collaterals (χ2=21.662, P<0.01; r=0.770, P<0.01). The rates of intracranial hemorrhage (6/12, 7/13, 1/8; χ2=7.337, P=0.027) and mortality (6/12, 1/13, 0/8; χ2=8.017, P=0.009) showed statistically significant difference among 3 groups. The rates of independent living of reperfused patients (achieving modified Treatment In Cerebral Ischemia scale (mTICI) 2b or 3) in 3 groups were 0/8, 6/11 and 8/8 (χ2=17.196, P<0.01; r=0.770, P<0.01), respectively. Conclusion DSA-based ACG is a simple and effective tool in predicting clinical outcomes in patients with LAO in anterior circulation after mechanical reperfusion therapy, and low ACG grades indicate poor outcome despite reperfusion. Key words: Acute ischemic stroke; Collaterals; Mechanical reperfusion; Digital subtraction angiography
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