Clinical Outcome Predicted by Collaterals Depends on Technical Success of Mechanical Thrombectomy in Middle Cerebral Artery Occlusion

被引：23

作者：

Gersing, Alexandra S. ^{[1
,2
]}

Schwaiger, Benedikt J. ^{[1
,2
]}

Kleine, Justus F. ^{[1
]}

Kaesmacher, Johannes ^{[1
]}

Wunderlich, Silke ^{[3
]}

Friedrich, Benjamin ^{[1
]}

Prothmann, Sascha ^{[1
]}

Zimmer, Claus ^{[1
]}

Boeckh-Behrens, Tobias ^{[1
]}

机构：

[1] Tech Univ Munich, Klinikum Rechts Isar, Dept Neuroradiol, Ismaninger Str 22, D-81675 Munich, Germany

[2] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94143 USA

[3] Tech Univ Munich, Klinikum Rechts Isar, Dept Neurol, Munich, Germany

来源：

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES | 2017年 / 26卷 / 04期

关键词：

Stroke; mechanical thrombectomy; collateralization; endovascular therapy; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CT ANGIOGRAPHY; ISCHEMIC-STROKE; INTRAARTERIAL TREATMENT; FUTILE RECANALIZATION; METABOLIC SYNDROME; SCORE; THROMBOLYSIS; CIRCULATION; MANAGEMENT;

D O I：

10.1016/j.jstrokecerebrovasdis.2016.10.020

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

Background: This study aimed to analyze the effects of technical outcome of mechanical thrombectomy (MTE) on the associations between collateral status, assessed with pretreatment computed tomography angiography (CTA), and neurological and functional outcome, as well as associations between collaterals and metabolic risk factors (arterial hypertension, diabetes, hyperlipidemia, overweight). Methods: Prospectively collected data of 115 patients with CTA-proven isolated middle cerebral artery occlusion treated successfully with MTE (Thrombosis in Cerebral Infarction [TICI] scale 2b or 3) were assessed retrospectively. Initial CTAs were assessed for the regional leptomeningeal collateralization score (rLMC), neurological status was determined with the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge, and mid-term functional outcome was assessed using the modified Rankin scale (mRS) 90 days after MTE. Results: NIHSS score at admission was significantly associated with rLMC (P = .004), whereas rLMC and NIHSS at discharge showed no significant associations (P = .12). Better rLMC was significantly associated with improved mid-term mRS (P = .018). This association was even more significant after complete MTE (TICI 3; P = .011). Arterial hypertension was significantly more often found in patients with poor rLMC (010) than in patients with good rLMC (11-20; P = .046), yet other risk factors showed no significant associations (P > .05). Conclusions: In patients with successful MTE, good collaterals were associated with better neurological status at admission and favorable mid-term functional outcome. In patients with complete MTE, associations were even more significant compared with those with "almost complete" MTE, suggesting a synergistic effect between good collaterals and complete MTE and a predictive value of collaterals for estimation of the potential clinical benefit of MTE.

引用

页码：801 / 808

页数：8

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