The Influence Of Collateral Circulation On DWI Lesion Pattern And Prognosis Of Patients With Severe Stenosis And Occlusion Of Anterior Circulation

BackgroundSevere intracranial vascular stenosis accounts for a large proportion of the high-risk population of recurrence.However,stenosis does not fully reflect the risk of recurrence.On the contrary,the establishment of collateral circulation is more important for its prognosis.Studies have shown that good collateral circulation is critical to improving the prognosis of patients with acute ischemic stroke(AIS).In all stroke populations,infarcts caused by the anterior circulation blood supply area account for 80% of all cerebral infarctions.MRI(DWI)is the most sensitive imaging method for early assessment of AIS,which can comprehensively assess the distribution of infarcts and the shape of the lesions,which is called DWI infarct mode.At present,there are few studies on DWI infarct patterns of cerebral infarction,and the influence of collateral circulation on its infarct patterns is even more limited.ObjectiveTo explore the effect of collateral circulation classification on the DWI infarction pattern and prognosis of patients with severe stenosis and occlusion of the anterior circulation.MethodsThis study is a prospective case-control study.After being excluded,it was finally included in 89 cases of symptomatic anterior circulation severe intracranial vascular stenosis or occlusion who were hospitalized in the Department of Neurology of our hospital from September 2018 to March 2020.In patients with collateral circulation,one-stop CTA-CTP was used to assess the utilization of collateral circulation.According to the collateral compensation,they were divided into two groups,39 cases in the poor collateral circulation group and 50 cases in the good collateral circulation group.Clinical data of the patients were collected and compared Risk factors affecting the formation of collateral circulation.According to MRI(DWI),each patient’s infarct location was recorded.Pial infarct(PI)、Perforating artery infarct(PAI)、Porder-zone infarct(BZI)、Large territory infarct(LTI)、Multiple infarcts(MI)were compared,and the prognosis was evaluated with NIHSS score and modified Rankin scale(m RS).Results1.The results of logistic regression analysis showed that HDL-C and Hcy were independent risk factors for the formation of collateral circulation(P < 0.05).2.The constituent ratio of PAI in good collateral group was higher than that in poor collateral group,while Bzi and MI in good collateral group were lower than those in poor collateral group,the differences were statistically significant(P < 0.05).3.The NIHSS score of good collateral group was significantly lower than that of poor collateral group on the 14 th day of onset(P < 0.05).The results of the Mrs score on the 14th and 90th day of the disease were better than those in the bad group,and the results of the MS score on the 90th day of the disease in the good side branch group were better than those in the 14 day of the onset,and the difference was statistically significant(P<0.05).Conclusions1.The distribution of DWI infarction patterns in patients with good collaterals is the most common with PAI,while patients in the poor collaterals group are mostly unilateral BZI and MI are the most common.2.The classification of collateral circulation can be used as an evaluation index for the functional prognosis of AIS patients with severe stenosis or occlusion of the anterior circulation.