摘要
目的 分析颈内动脉颅内闭塞(IICAO)患者CTA图像,判断经Willis环的初级侧支循环,评估血管内机械取栓术(EVMT)预后良好的相关因素。方法 对162例行EVMT治疗的IICAO患者进行分析。搜集基线资料包括人口统计学特征、血管危险因素、ASPECTS评分、NIHSS初始评分、术后再出血例数。根据CTA图像将Willis环的形态分为4种,并结合颈动脉闭塞位置及Willis环变异情况,将初级侧支循环分为4组。通过90天后改良Rankin量表(mRS)评分来衡量术后临床结局,判断取栓术预后良好的相关因素。结果 在162例IICAO患者中,出院38.3%(62例)取栓治疗后mRS 0~2分;预后良好29.0%(47例)mRS 3~5分;死亡32.7%(53例)mRS 6分。三组间基线资料中年龄、入院NIHSS评分及房颤有统计学差异(P<0.05),Willis发育变异比例无统计学差异(P>0.05),有无初级侧支循环有统计学差异(P<0.05),其中无初级侧支循环的患者死亡率57.1%。在多变量Logistic回归中,房颤及血流循环分组为预后良好的相关因素。结论 基于颈动脉闭塞位置,结合Willis环变异联合判断是否存在初级侧支循环可能是IICAO患者EVMT后疗效的预测因子。
Objective To evaluate the outcome of intracranial internal carotid artery occlusion(IICAO)after EVMT a-long with primary collateral circulation of acute intracranial internal carotid artery occlusion based on Willis circle variation.Methods In all,162 patients with IICAO treated by EVMT were evaluated.Baseline data were collected including demo-graphic characteristics,vascular risk factors,ASPECTS,and initial NIHSS score.The number of hemorrhagic transformation cases were counted.The variation of Willis'circle was categorized into four degrees.Combined with the location of the IICAO and Willis'circle variation,the retrograde flow direction was divided into four groups.Postoperative clinical outcomes were measured by mRS(Modified Rankin Scale)at 90 days to determine the association between multiple factors and good clinical outcomes.Results Among the 162 patients with IICA0,38.3%(62cases)showed improved clinical efficacy after thrombectomy(mRS 0-2),29.0%(47 cases)did not recover(mRS 3-5),and 32.7%(53 cases)died(mRS 6).There were statistically significant differences in age,admission NIHSS score and atrial fibrillation among the three groups(P<0.05).There was no statistical difference in the proportion of Willis development variation among the three groups with dif-ferent clinical outcomes(P>0.05),and there was statistical difference between the presence and absence of primary col-lateral circulation(P<0.05).The mortality rate of patients without primary collateral blood flow was 57.1%.Multivariate Logistic regression analysis showed that primary collateral circulation and atrial fibrllation were predictors of favorable out-comes.Conclusion Primary collateral circulation based on Willis variation may be potential predictors of favorable out-comes for patients with IICAO after EVMT.
作者
吴文娟
成月
蒋璟璇
蔡冬梅
张雷
WU Wenjuan;CHENG Yue;JIANG Jingxuan(Department of Radiology,Wuxi Second People's Hospital,Wuxi,Jiangsu Province 214002,P.R.China)
出处
《临床放射学杂志》
北大核心
2023年第6期905-909,共5页
Journal of Clinical Radiology
基金
无锡市“双百”中青年医疗卫生拔尖人才培养计划项目(编号:HB2020029)。
关键词
WILLIS环
初级侧支循环
血管内机械取栓术
CTA
颈内动脉颅内闭塞
预后
Willis'circle
Primary collateral circulation
Endovascular mechanical thrombectomy
CT angiography
Intracranial internal carotid artery occlusion
Prognosis
