Correlation Analysis Of Collateral Circulation With Tissue Prognosis And Clinical Outcome Of Endovascular Treatment In Acute Ischemic Stroke Patients

Background:In several randomized trials,collateral status modified the the effect of endovascular treatment(eVT)for stroke in several randomized trial.We assessed the associations between collateral circulation and revascularization status,long-term prognosis,short-term clinical outcomes,and tissue future in patients receiving EVT.Methods:Retrospective analysis was performed on patients with acute anterior circulation aortic occlusion within 6 hours after onset from October 2017 to July 2019,a total of 224 patients were included.Digital subtraction angiography(DSA)was used to evaluate the collateral circulation.Brain edema was evaluated on CT 24h after EVT and hemorrhagic transformation was assessed according to European Cooperative Acute Stroke Study(ECASS ?).Short-term prognosis was assessed by the National Institutes of Health Stroke Scale(NIHSS)at 1d and 7d after surgery,and cranial CT was used to grade hemorrhagic transformation and edema.Functional outcomes were assessed at 90 days using the modified Rankin Scale(mRS),with 0-3 defined as a good prognosis.The effects of collateral circulation on reperfusion treatment and prognosis were analyzed,as well as multivariate analysis of malignant edema and hemorrhagic transformation.Short-term prognosis was assessed using the National Institutes of Health Stroke Scale(NIHSS)at 24h and 7d.Modified Rankin Scale(mRS)was used to assess clinical outcome at 90d.The correlation of collateral circulation between reperfusion treatment and prognosis were analyzed,as well as multivariate analysis of malignant edema and hemorrhagic transformation.Results:1.There were significant differences in patients with different collateral states at 1d and 7d after NIHSS,blood flow classification,hemorrhagic transformation classification,edema classification,and infarct volume(p<0.05 or p<0.01).Compared with patients with moderate and good collaterals,patients with poor collaterals had higher NIHSS scores at 1d and 7d after operation,high degree of edema grade and larger infarct volume,and more frequent 24-hour bleeding transformation.Multivariate Logistic regression analysis showed age(OR=1.069,95%CI=1.016-1.124,p=0.010),edema grade(OR=2.011,95%CI=1.173-3.447,p?0.011),blood glucose(OR?1.384(95%CI=1.078-1.776,p?0.011)is a risk factor for poor prognosis(p<0.05).2.Multivariate linear regression analysis showed that the predictive factors for the improvement of the 24h NIHSS score less than<50%include adverse collateral blood flow(OR=0.461,95%CI?0.243-0.877,p?0.018),and infarct volume(OR?1.028,95%CI?1.008-1.048,p?0.005).In the subgroup analysis of side branch differences,the results showed that blood flow classification was associated with good prognosis(x2?6.938,p=0.018).3.The results of multiple linear regression analysis of the NIHSS score at 7 days after operation showed that the collaterals(beta?-2.007,p=0.044)and core infarct volume(beta=0.159,p?0.001)were correlated with 7d NIHSS(p<0.05).4.Multivariate regression analysis of malignant cerebral edema showed infarct volume(OR?1.024,95%CI=1.009-1.039,p?0.002),and poor collaterals(OR?0.407,95%CI?0.027-6.044,p?0.048).)Is a risk factor.5.Multivariate regression analysis results of parenchymal hemorrhage showed TOAST classification(p=0.047),edema classification(OR?2.780,95%CI?1.651-4.682,p=0.000),low LDL-C(OR=0.847,95%CI?1.042-3.640,p?0.037)was an independent risk factor(p<0.05).Conclusion:The pre-treatment status of collaterals have effect on revascularization status,short-term neurological prognosis,and tissue prognosis(infarct core and final infarct volume,malignant edema,and hemorrhagic transformation).Collaterals are not related to time from onset to puncture.There is no significant difference in prognosis and clinical outcome characteristics between patients in the late window and early window.Patients with poor collaterals may still be beneficial from EVT.Good collaterals are associated with better short-term neurological function but collaterals cannot predict long-term prognosis.LDL may have some predictive value in short-term prognosis,hemorrhagic transformation transformation and clinical outcome.