The Correlation Between Collateral Circulation Assessment And Prognosis Of Intravenous Thrombolytic Therapy In Patients With Acute Ischemic Stroke By NIHSS Score Combined With DSA Examination

ObjectiveTo discuss the correlation between collateral circulation assessment and prognosis of intravenous thrombolytic therapy in patients with acute ischemic stroke(AIS)by national institute of health stroke scale(NIHSS)score combined with digital subtraction angiography(DSA)examination.MethodsRetrospective analysis of 85 AIS patients treated with intravenous thrombolysis and DSA vascular evaluation after intravenous thrombolysis was performed before treatment in our hospital from Jan 2015 to Jan 2017,according to the results of DSA examination were divided into large vessel occlusion group(47 cases)and non large vessel occlusion group(38 cases).There were 28 male patients and 19 female patients in the large vessel occlusion group,age range from 29 to 77 years,average age(61.29±8.57)years;There were 25 male patients and 13 female patients in the large vessel occlusion group,age range from 28 to 79 years,average age(62.03±8.79)years.Recorded and compared the NIHSS scores and mRS scores of two groups of AIS patients before and after treatment,and the univariate Logistic regression analysis and multivariate Logistic regression analysis were used to analyze the independent risk factors of large vessel occlusion in NIHSS score sub-item.Inclusion criteria:(1)Refer to the "2014 Chinese guidelines for diagnosis and treatment of acute ischemic stroke" constituted by cerebral vascular disease group of the Chinese Medical Association neurology branch in 2015;(2)the NIHSS scores of all patients≥12;(3)Onset time to visiting time<4.5h;(4)All patients were diagnosed as ischemic stroke then intravenous thrombolytic therapy and further DSA vascular evaluation;(5)The patient and(or)family members had informed consent.Exclusion criteria:(1)The patient’s medical records were incomplete;(2)Patients with previous stroke residual nerve function defect and mRS>2 points;(3)Patients had intravenous thrombolytic and contraindication for DSA examination;(4)Patients with posterior circulation stroke.ResultThe NIHSS scores of non large vessel occlusion group AIS patients before treatment and after 1 day,1 week and 1 month treatment were(13.97±1.48)points,(9.37±1.31)points,(8.06±1.22)points and(4.31±0.95)points respectively,the large vessel occlusion group AIS patients were(17.55±1.71)points,(9.37±1.31)points,(13.76±1.39)points and(11.88±1.17)points respectively,the non large vessel occlusion group were significantly lower than large vessel occlusion group,which were statistically significant(P<0.05);The two groups of AIS patients were followed up for 3 months after admission,after 3 months of treatment,the mRS scores of two groups of patients with AIS were significantly decreased,and the mRS scores of AIS patients in non large vessel occlusion group was significantly decreased,which were statistically significant(P<0.05);The collateral circulation compensatory degree of the non large vessel occlusion group(2.92±0.55)grade was significantly higher than the large vessel occlusion group(1.87±0.37)grade,which was statistically significant(P<0.05);3 months after thrombolytic therapy,the mRS score was negatively correlated with the collateral circulation compensatory degree(r=-0.792,P<0.05),indicating that the prognosis of the non large vessel occlusion group AIS patients with high collateral circulation compensatory degree was better.Univariate Logistic regression analysis was used in the NIHSS score sub-item,the results showed that consciousness level(OR= 1.527,95%CI:0.755~2.428),consciousness level questioning(OR=1.082,95%CI: 1.019~1.153),consciousness level instruction(OR=1.116,95%CI:0.951~1.293),gaze(OR=1.325,95%CI:0.943~1.647),body ataxia(OR=1.364,95%CI:1.161~1.924),feel(OR=1.027,95%CI:0.938~1.242),language(OR=0.931,95%CI:0.894~1.428),neglect(OR=1.437,95%CI:0.922~1.951)were possible risk factors for large vascular occlusion;Then used large vessel occlusion as a dependent variable further multivariate Logistic regression analysis was performed,the results showed that consciousness level(OR=1.626,95%CI:1.325~2.128),consciousness level questioning(OR=1.453,95%CI: 1.102~1.948)and gaze(OR=1.257,95%CI:1.034~1.627)were independent risk factors for AIS patients with vascular occlusion(all P<0.05).ConclusionAfter DSA examination found that the prognosis of non large vessel occlusion AIS patients with good collateral circulation is better after intravenous thrombolysis,collateral circulation can predict long-term functional prognosis in patients with ischemic stroke,and the independent risk factors for the assessment of large vessel occlusion were the level of consciousness,consciousness questioning and gazein the NIHSS scoring program.