| Objective:The cerebral vascular stenosis or occlusion, blood supply and collateral circulation in ischemic stroke patients are observed through digital subtraction angiography(DSA) examination on head. The way and number of collateral circulation and the scope and extent of compensatory are recorded. The relationship between collateral circulation and ischemic stroke is discussed. The prognoses of ischemic stroke patients with different collateral circulation conditions are compared. It is provide a reliable basis of ischemic stroke for effective prevention, treatment options and prognosis evaluation.Methods : The research objects were the 83 cases with ischemic stroke in the Cardiovascular department of our hospital from June 2013 to May 2013, and all of them were examined by MRI or CT for at least 1 or more cerebral arteries with severe stenosis or occlusion. The stenosis or occlusion site, the establish and types of collateral and compensatory in all the patients were analyzed by DSA examination. According to the existence of compensatory collateral, the patients were divided intocollateral compensatory non-open group(n=33) and collateral compensatory open group(n=50). The collateral compensatory open group was divided into primary compensatory group(n=10),secondary compensatory group(n=11) and combined compensatory group(primary compensatory and secondary compensatory)(n=29) according to opening of collateral circulation. The combined compensatory group was divided into pial arteries blood compensatory group(n=11), ophthalmic artery blood compensatory group(n=8) and multi-pathway blood compensatory group(n=10) according to compensatory blood supplying.Patients were treated with arterial mechanical fragmentation and urokinase thrombolysis. All patients were treated with the National Institutes of Health Stroke Scale(NIHSS) in pre-operation and7 days, 3 months and 1 year after operation and modified Rankin score(m RS) in 1 months and 1 year after operation, and analyzed the effect ofcollateral circulation on the prognosis of ischemic stroke. The effect of collateral circulation on prognosis of ischemic stroke was analyzed.Results:(1) The comparison of results of collateral compensatory open group and collateral compensatory non-open group① Based clinical data : The number of patients with hypertension in collateral compensatory open group was significantly higher than that in collateral compensatory non-open group(P<0.05).② Imaging examinations:Single lesion in collateral compensatory non-open group was 42.4% which was significantly lower than 68.0% in collateral compensatory open group(P=0.021), and multiple lesions in collateral compensatory non-open group was57.6% which was significantly lower than 32.0% in collateral compensatory open group(P=0.037). The lesion mainly occurred in the basal ganglia brain lobe, brain stem,cerebellum and thalamus, and there was significant difference in the incidence of lesions in the brain stem in two groups(P=0.041). The moderate stenosis rate and occlusion rate were respectively compared in two groups, the difference were statistically significant(P=0.008;P=0.001). The degree of nerve function defect was evaluated in two groups by NIHSS score before treatment. The patients with moderate neurologic deficit in collateral compensatory open group(4 cases, 12.1%) was significantly lower than(17 cases, 34.0%)in collateral compensatory non-open group(P=0.025), and patients with severe neurologic deficit in collateral compensatory open group(17 cases, 51.5%) was significantly higher than(12 cases, 24.0%) in collateral compensatory non-open group(P=0.010)(2) Collateral compensative①The type of collateral circulation: The number of primary compensatory, secondary compensatory and combined with primary compensatory and secondary compensatory were 10(20.0%), 11(22.0%) and 29(58.0%), respectively by DSA in collateral compensatory open group. And in the patients whose type of collateral circulation was combined with primary compensatory and secondary compensatory, the number of pial arteries blood compensatory, ophthalmic artery blood compensatory and multi-pathway blood compensatory were 11(37.9%), 8(27.6%) and 10(34.5%), respectively.② Comparison of the results of risk factors: In the primary compensatory group,secondary compensatory group and combined compensatory group which compensatorycollateral had been open, there was no statistically significant in the risk factors of complications(hypertension, diabetes, hyperlipidemia, coronary heart disease), smoking history, drinking history(P>0.05).③ The relationship between the type of collateral circulation and compensatory blood supplying mode with the degree of artery stenosis: There was no secondary collateral circulation compensatory in the patients with moderate arterial stenosis(P=0.000). Secondary collateral circulation compensatory and combined circulation compensation was common in the patients with severe arterial stenosis and occlusion. And it was compared with primary collateral circulation compensatory, the differences were statistically significant(P=0.048,P=0.007). In the cases of severe arterial stenosis, pial arteries blood compensatory is the main way(P=0.024) in combined compensatory group,and multi-pathway blood compensatory mainly occurred in the case of arterial occlusion(P=0.049).(3) The relationship between collateral compensative with clinical efficacy and prognosis① HINSS score: The HINSS score in collateral compensatory open group was significantly lower than that in collateral compensatory non-open group in pre-operation and 1 year post-operation(P<0.05). In 7 days, 3 months and 1 year after operation, the HINSS score of primary compensatory group, secondary compensatory group and combined compensatory group was respectively compared, the differences were statistically significant(P<0.01). But the HINSS score was no significant difference in pial arteries blood compensatory group, ophthalmic artery blood compensatory group and multi-pathway blood compensatory group(P>0.05). The number of patients whose NIHSS score increased more than 4 point in collateral compensatory open group was higher than that in collateral compensatory non-open group in 1 year post-operation(P=0.041). In 7days, 3 months and 1 year after operation, the number of patients whose NIHSS score increased more than 4 point in combined compensatory group was compared respectively with primary compensatory group and secondary compensatory group, the differences were statistically significant(P<0.05). But the number of patients whose NIHSS score increased more than 4 point was no significant difference in pial arteries blood compensatory group, ophthalmic artery blood compensatory group and multi-pathway blood compensatory group(P>0.05).② m RS score: The m RS score in collateral compensatory open group was significantly lower than that in collateral compensatory non-open group in 1 month and 1year post-operation(P<0.05). In 1 month and 1 year post-operation, the m RS score of primary compensatory group, secondary compensatory group and combined compensatory group was respectively compared, the differences were statistically significant(P<0.01).But the m RS score was no significant difference in pial arteries blood compensatory group,ophthalmic artery blood compensatory group and multi-pathway blood compensatory group(P>0.05). The number of patients whose m RS score was 0 to 2 in collateral compensatory open group was higher than that in collateral compensatory non-open group in 1 year post-operation(P=0.021). In 1 months and 1 year after operation, the number of patients whose m RS score was 0 to 2 in combined compensatory group was compared respectively with primary compensatory group and secondary compensatory group, the differences were statistically significant(P<0.01). But the number of patients whose m RS score was 0 to 2 was no significant difference in pial arteries blood compensatory group,ophthalmic artery blood compensatory group and multi-pathway blood compensatory group(P>0.05).Conclusion:(1) Cerebral vascular risk factors have an impact on the role of collateralcirculation, in particular, high blood pressure can promote the establishment of collateral circulation.(2) In collateral compensatory open group, good collateral circulation can reduce the incidence of lesions, reduce the degree of ischemic tissue damage and improve the prognosis.(3) It is related between effective collateral circulation and the number of collateral circulation with the degree of cerebral artery stenosis. The arterial stenosis is more severe,the higher frequency and level of collateral compensatory opening. The establishment of collateral circulation and its number determines the intracranial arterial stenosis or occlusion of blood flow to brain tissue perfusion in a large extent.(4) In the patients with severe arterial stenosis and occlusion, the main way of collateral compensation is secondary compensatory and combined compensatory. Pial arteries blood compensatory is the based compensation in the case of severe arterial stenosis, and multi-pathway blood compensatory is the based compensation in the case of arterial occlusion.(5) Compensatory collateral circulation including primary and secondary compensatory collateral circulation indicates a good prognosis. But the way of compensatory blood supplying has no significant effect on prognosis. |
PDF Full Text Request