Collateral Circulation And Its Relationship With Clinical Symptoms And Short-time Prognosis In Acute Cerebral Infarction On CTA

Objectives Analyzing the clinical data of 352 patients with acute cerebral infarction who underwent head 256-slice spiral CT angiography(CTA)during hospitalization,in order to understand the formation of collateral circulation in patients with acute cerebral infarction,analyze the influencing factors of the formation of collateral circulation,explore the relationship between cerebral collateral circulation and clinical symptoms and short-term prognosis,and provide the basis for clinical decision-making and short-term prognosis.Methods 1 352 patients with acute cerebral infarction from Jan.2015 to Dec.2016 in the neurology department of Affiliated Hospital of North China University of Science and Technology were enrolled and all received 256-slice spiral CTA of head and neck.According to the formation of collateral circulation in the head and neck CTA imaging results,it is divided into collateral circulation group and none collateral circulation group.30 patients were examined by DSA at the same time to analyze the sensitivity,specificity and consistency of CTA on the diagnosis of cerebral collateral circulation.2 Comparing the clinical data of the two groups to analyze the influencing factors of the formation of collateral circulation in patients with acute cerebral infarction.3 using the national institute of health stroke scale(NIHSS)and barthel index(BI)scale to assess the NIHSS score and activities of daily living(ADL)score of all selected patients on the first and 14 th day of hospitalization.According to NIHSS score,ADL score,condition progress,recovery of clinical symptoms and signs of of patients to evaluate the patient’s short-term prognosis and analyze the effect of collateral circulation on the short-term prognosis of patients with acute cerebral infarction.4 Calculating the cerebral infarct volume at 7 days after admission to analyze the relationship between the formation of cerebral collateral circulation and infarct volume.5 According to the progress of the disease or not,it was divided into progressive and non progressive cerebral infarction.According to the oxfordshire community stroke project(OCSP)classification to perform OCSP typing.Analyzing the effect of collateral circulation on the recovery of neurological function and the activity of daily living in patients with different types of cerebral infarction.6Statistical method: data were analyzed by SPSS(17.0)software.Two samples were compared between t test and chi-square test.Pair counting data application Mc Nemar Test and Kappa Test.Grade data were compared using the Mann-Whitney U rank sum test,and multivariate analysis was performed using logistic regression analysis.Results 1 352 cases of acute cerebral infarction patients: male228(64.8%),females124(35.2%).Age: 47-84 years old,average 59.21±11.42.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 74cases(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%).2 256-layer spiral CTA have a high compliance rate(90.0%)in the assessment of the collateral circulation compared with DSA.CTA has a high agreement with the DSA on the assessment of the formation of different levels of collateral(Kappa test,primary collateral k= 0.925,secondary collateral k=0.894).3 Single factor of collateral circulation analysis showed that age,hypertension and diabetes,history of TIA,low density lipoprotein,homocysteine,cerebrovascular stenosis,posterior circulation lesion as factors influencing the formation of collateral circulation(P<005).Multivariate Logistic regression analysis showed that age,hypertension and diabetes,homocysteine,and posterior circulation lesion were the relative independent risk factors for none collateral circulation in patients with acute cerebral infarction(OR>1,P<0.05),and low density lipoprotein,cerebrovascular stenosis were protective factors(OR<1,P<0.05).4 the NIHSS scores and the degree of ADL deficiency on the 14 th day of hospitalization in collaterals group were significantly lower than in none collateral group(t=-4.105,P=0.000;Z=-3.784,P=0.000).5 The volume of cerebral infarction in patients with collateral circulation was significantly smaller than that in patients with none collateral circulation(Z =-2.597,P = 0.009).6 In 352 cases of acute cerebral infarction,97 cases(27.6%)were progressive cerebral infarction and 255cases(72.4%)were none progressive.The proportion of collateral circulation in progressive cerebral infarction was lower than in non-progressive(X2 =10.195,P=0.002).In cases of progressive and non-progressive cerebral infarction,the NIHSS scores and the degree of ADL deficiency on admission and treatment for 14 days in none collateral group were significantly higher than in collaterals group(progressive cerebral infarction:t=2.567,P=0.012;Z=-2.152,P=0.031,non-progressive cerebral infarction:t=2.371,P=0.019;Z=-2.437,P=0.015).7 Among the 352 patients with acute cerebral infarction,there were 41 cases of TACI,141 cases of PACI,92 cases of POCI and 78 cases of LACI.OCSP subtypes of collateral circulation distribution was statistically significant(X2=17.364,P=0.001).PACI type proportion of collateral circulation is the largest(68.8%),Compared with other subtypes of collateral circulation,the difference was statistically significant(all P < 0.05).The NIHSS scores and the degree of ADL deficiency on the 14 th day of admission with collateral circulation of the patients with TACI type and PACI type were significantly lower than that with none collateral circulation(TACI:t=2.288,P=0.028,Z=-2.492,P=0.013;PACI: t=2.950,P=0.004,Z=-3.182,P=0.001);The differences of the NIHSS scores and the degree of ADL deficiency on the 14 th day of admission between collateral circulation with none collateral circulation of the patients with POCI type and LACI type were both not statistically significant(POCI:t=1.931,P=0.057,Z=-1.807,P=0.071;LACI:t=0.959,P=0.340,Z=-0.880,P=0.379).Conclusions 1 256-slice spiral CTA has a high correlation with DSA in the assessment of cerebral collateral circulation.2 Old age,hypertension and diabetes,high homocysteine and posterior circulation lesions are risk factors for the formation of collateral circulation in patients with acute cerebral infarction,cerebral vascular stenosis degree and low density lipoprotein can promote the formation of collateral circulation.3 The formation of collateral circulation in patients with acute cerebral infarction is helpful to promote the recovery of short-term neurological function and daily living activity,improve the clinical prognosis and reduce the infarct volume.4 The collateral circulation formation of patients in progressive cerebral infarction is poor.The recovery of neurological function in patients with acute cerebral infarction without collateral circulation is poor.5 In OCSP subtypes of patients with acute cerebral infarction,PACI type of cerebral collateral circulation formation is good up to see.For the type of TACI and PACI,the formation of collateral circulation is beneficial to the recovery of patient’s shot-time neurological function and the ability of daily life.For the type of POCI and LACI,the formation of collateral circulation has no significant effect on the recovery of patient’s short-term prognosis.