| BackgroundIn recent years,collateral circulation,as a new way to improve cerebral ischemia area blood flow perfusion,has become a research hotspot.Good collateral circulation can significantly improve the prognosis of patients with acute ischemic stroke(AIS)and reduce the risk of stroke recurrence;therefore,the study of the factors that affect the formation of collateral circulation and its relationship with prognosis is conducive to finding a new type of assistant segment for stroke treatment.At present,there are few studies on the patients with severe stenosis and occlusion of large intracranial atherosclerosis,and there is no unified conclusion.In this study,we analyzed the data of patients with severe stenosis and occlusion of middle cerebral artery and determined the influencing factors of AIS collateral circulation and its relationship with prognosis.ObjectiveTo analyze the influencing factors of AIS collateral circulation formation in M1 segment of middle cerebral artery with severe stenosis and occlusion and its influence on long-term clinical prognosis.MethodsFrom September 2017 to August 2019,71 patients with severe stenosis and occlusion of M1 segment of middle cerebral artery in my Hospital were included in the study,including 29 patients with poor collateral circulation and 42 patients withgood collateral circulation.The clinical data and laboratory examination indexes of the patients were collected,and the clinical scale was evaluated;the factors influencing the formation of collateral circulation and its relationship with prognosis were studied by multivariate logistic regression analysis,and the correlation between blood homocysteine and total cholesterol and the scores of NIHSS and mRS was studied by Spearman rank correlation analysis.ResultsMultivariate logistic regression analysis showed that homocysteine was negatively correlated with collateral circulation(OR=1.074,95%CI: 1.018-1.132,P=0.009);total cholesterol was negatively correlated with collateral circulation(OR=2.078,95%CI: 1.117-3.867,P=0.021).Spearman rank correlation analysis showed that the level of homocysteine was positively correlated with NIHSS score(OR= 0.365,P= 0.002)and mRS score(OR= 0.395,P=0.001)within 24 hours after admission.The NIHSS score(z =-3.363,P = 0.001)and the first mRS(z =-2.596,P= 0.009)in the group with good collateral circulation were lower than those in the group with poor collateral circulation.The difference of mRS score between groups was statistically significant at 3 months(z=-2.337,P=0.019)and 6 months(z=-3.735,P < 0.01).In the 3 months clinical outcome,66.7% of the patients with good collateral circulation and 34.5% of the patients with poor collateral circulation had a mRS score of 0-1(multivariate adjusted OR= 4.84,95% CI: 1.28-18.22,P=0.02);76.2% of the patients with good collateral circulation and 48.3% of the patients with poor collateral circulation had a mRS score of 0-2(multivariate adjusted OR= 5.18,95% CI:1.38-19.35,P=0.014).At 6 months of clinical outcome,78.6% of patients with good collateral circulation and 41.4% of patients with poor collateral circulation had a mRS score of 0-1(multivariate adjusted OR= 8.75,95% CI: 2.37-32.66,P=0.001);88.1%of patients with good collateral circulation and 65.5% of patients with poor collateral circulation had a mRS score of 0-2(multivariate adjusted OR = 2.50,95% CI:0.60-10.45,P = 0.208).3 and 8 patients in the good collateral circulation group and the bad collateral circulation group had stroke recurrence respectively(OR= 0.10,95% CI: 0.01-0.69,P = 0.02).ConclusionsFor AIS patients with severe stenosis and occlusion of M1 segment of middle cerebral artery,high blood total cholesterol and homocysteine are not conducive to the formation of collateral circulation;patients with low homocysteine level and good collateral circulation have light neurological deficit and good quality of life;good collateral circulation can improve the long-term excellent functional outcome of patients and can reduce the risk of stroke recurrence. |
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