CAJ | 학술논문

目的探讨急性缺血性卒中患者前循环大动脉闭塞后侧支循环丰富程度与再通术后预后的关系.方法回顾经动脉途径(包括机械取栓、急诊支架成形术等)治疗的所有前循环急性缺血性卒中患者的临床资料及其术前血管造影所见侧支循环代偿程度,分析其与预后的关系.侧支循环代偿程度的评估采用美国神经介入治疗协会侧支分级系统(ACG).结果共纳入患者33例,其中ACG0～1级者12例,2级13例,3～4级8例;3组术后3个月预后良好(改良Rankin量表评分0～2分)率(分别为0/12、6/13、8/8)、7d内颅内出血率(分别为6/12、7/13、1/8)、3个月内病死率(分别为6/12、1/13、0/8)差异均有统计学意义(x2 =21.662,P＜0.01;x2 =7.337,P=0.027;x2 =8.017,P =0.009),代偿充分的组别预后良好率优于代偿不足者,颅内出血事件发生率及病死率低于代偿不足的组别;且再通患者(27例)中不同ACG亚组间良好预后率分别为0/8、6/11、8/8(x2=17.196,P＜0.01; Spearman相关系数r=0.770,P＜0.01).结论血管造影ACG分级简便快速,能够较好预测前循环大动脉闭塞的患者机械开通术后临床结局,分级低的患者即使血管再通也倾向于结局不良.
목적 탐토급성결혈성졸중환자전순배대동맥폐새후측지순배봉부정도여재통술후예후적관계.방법 회고경동맥도경(포괄궤계취전、급진지가성형술등)치료적소유전순배급성결혈성졸중환자적림상자료급기술전혈관조영소견측지순배대상정도,분석기여예후적관계.측지순배대상정도적평고채용미국신경개입치료협회측지분급계통(ACG).결과 공납입환자33례,기중ACG0～1급자12례,2급13례,3～4급8례;3조술후3개월예후량호(개량Rankin량표평분0～2분)솔(분별위0/12、6/13、8/8)、7d내로내출혈솔(분별위6/12、7/13、1/8)、3개월내병사솔(분별위6/12、1/13、0/8)차이균유통계학의의(x2 =21.662,P＜0.01;x2 =7.337,P=0.027;x2 =8.017,P =0.009),대상충분적조별예후량호솔우우대상불족자,로내출혈사건발생솔급병사솔저우대상불족적조별;차재통환자(27례)중불동ACG아조간량호예후솔분별위0/8、6/11、8/8(x2=17.196,P＜0.01; Spearman상관계수r=0.770,P＜0.01).결론 혈관조영ACG분급간편쾌속,능구교호예측전순배대동맥폐새적환자궤계개통술후림상결국,분급저적환자즉사혈관재통야경향우결국불량.
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 (x2 =21.662,P ＜ 0.01 ; r =0.770,P ＜ 0.01).The rates of intracranial hemorrhage (6/12,7/13,1/8; x2 =7.337,P=0.027) and mortality (6/12,1/13,0/8; x2 =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 0/8,6/11and 8/8 (x2 =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.