Evaluation Of Collateral Compensation In Acute Posterior Circulation Ischemic Stroke And Analysis Of Its Influencing Factors

BackgroundStroke is one of the diseases with the highest rate of death and disability in China.Previous studies have found that Acute ischemic stroke(AIS)caused by proximal intracranial artery occlusion accounts for about one-third of all ischemic stroke patients.Compared with anterior circulation,posterior circulation acute ischemic stroke is more likely to progress in the acute phase,with higher mortality and poorer clinical prognosis.With the development of medical technology and related studies,the efficacy and safety of Endovascular therapy(EVT)for AIS caused by intracranial and external occlusion of large vessels have been verified.However,about 26%?49%of AIS patients still fail to obtain a good clinical prognosis even if they can achieve complete recanalization of blocked artery through EVT,which is more obvious in patients with Acute posterior circulation ischemic stroke(APCIS).Therefore,it is particularly important to select AIS patients before EVT.Collateral circulation(CS)is defined as the compensatory supply of blood to the region of the occluded artery to varying degrees through a pre-existing or newly formed vascular anastomosis network when the main artery is occluded.It can maintain the survival time of ischemic penumbra brain tissue as much as possible,thus extending the time window of EVT treatment.Meanwhile,good CS is also significantly correlated with higher vascular recanalization rate and lower postoperative complications.Therefore,for APCIS patients,the assessment of CS in the acute phase can provide more valuable guidance for the treatment decision and clinical prognosis of patients.At present,there are a variety of ways to evaluate brain CS,including Digital subtraction angiography(DSA),transcranial Doppler(TCD),CT angiography(CTA),computed tomography(CTP),Magnetic resonance angiography(MRA),magnetic resonance cerebral perfusion(MRP),etc.,but DSA is still considered to be the gold standard for CS evaluation.However,most of these assessment methods are for the former cycle,and the assessment methods for the latter CS mainly include DSA and CTA.It is well known that CS varies greatly from individual to individual,with many factors affecting CS,including age,hypertension,diabetes,statin use,metabolic syndrome,and Willis circle integrity.Previous studies have found that aging,chronic hypertension,hyperlipidemia and hyperglycemia may affect the CS of human body through the damage to vascular endothelial function and its self-regulation ability.Therefore,early detection and control of risk factors can improve the level of CS in patients to a certain extent,thus improving the clinical prognosis of patients.The purpose of this study is to evaluate CS in APCIS patients by DSA,so as to provide references for treatment strategies and clinical prognosis of patients.At the same time,the risk factors of these patients were evaluated to provide a basis for the acute phase management of patients.ObjectiveTo explore the guiding value of DSA posterior collateral circulation grading score in the endovascular treatment of patients with acute posterior circulation ischemic stroke and the clinical prognosis,and to evaluate the risk factors that may affect the status of posterior circulation collateral circulation.MethodsA retrospective analysis was performed on 75 patients who underwent intravascular therapy for acute posterior circulation ischemia in the department of endovascular therapy in our hospital from June 2016 to December 2019.DSA examination was performed on all patients.The modified American society of interventional and therapeutic neuroradiology/society of interventional radiology classification system(0-8 points)was used to score the posterior circulation collateral compensation.And the patients were divided into two groups by scoring,namely,the group with poor collateral circulation(<6 points)and the group with good collateral circulation(?6 points).The modified Rankin score 3 months after the operation was taken as the outcome,and the score of 3-6 was considered as poor clinical prognosis.The collected data were processed by SPSS23.0 software.All enrolled patients were divided into two groups according to their CS level and clinical outcome(mRS score)after 3 months.The independent sample t test was used to evaluate the difference of continuous variable data between groups,and the chi-square test was used to evaluate the difference of classification variables between groups.In the CS level group,Logistic regression analysis was performed on the variables with differences between the two to assess the influencing factors/predictors of CS levelResultsIn this study,a total of 75 patients with an average age of 55±7.89 years were included,including 40 male patients(53.33%).The NIHSS score and ASPECT score of the patients on admission were 9.85±2.20 and 5.32±1.46,respectively.There were 40 patients(53.33%)with good CS level.Of these patients,58(77.33%)achieved complete recanalization after EVT,and 46(61.33%)had a good clinical prognosis at 3 months.By analyzing the data grouped according to the clinical prognosis of patients at 3 months,we found that there were significant differences in NIHSS score,ASPECT score at admission,CS level,and complete occlusion vascular recanalization(TICI?2b)between the two groups(P<0.05),and no significant differences in residual variables between the two groups(P>0.05);Further Logistic regression analysis revealed that on admission,NIHSS score[Odds ratio(OR)2.16;95%Confidence interval(CI):1.007-4.632;P<0.05]and ASPECT score(OR,0.21;95%CI:0.002-0.277;P<0.05)and DSA-CS score(OR,0.28;95%CI:0.001-0.542;P<0.05)was an independent factor for clinical prognosis at 3 months.After analyzing the data grouped by CS level,we found that there were statistical differences between the two groups in age,diabetes,NIHSS score at admission and ASPECT score at admission(P<0.05).Further Logistic regression analysis revealed that age(OR,1.241;NIHSS score at admission(OR,2.33;95%CI:1.180-4.603;P<0.05)and ASPECT score on admission(OR,0.104;95%CI:0.022-0.506;P<0.05)is an independent predictor of CS level.Conclusions1?DS A-based posterior circulation CS score was an independent predictor of 3-month clinical prognosis in patients with acute posterior circulation ischemic stroke?2?Age,NIHSS score at admission and ASPECT score at admission are independent factors affecting the level of CS in patients with acute posterior circulation ischemic stroke.Therefore,early identification of these risk factors in clinical work may be conducive to screening patients who can benefit more from EVT treatment.