Association Between The Posterior Cerebral Artery Laterality And The Severity And Prognosis Of Stroke With The Middle Cerebral Artery Failure

Objective Acute ischemic stroke refers cerebral blood flow failure-leaded cerebral tissue anoxia and neurological symptoms.The morbidity and mortality rates of acute ischemic strokeare high.In recent years,the acute ischemic stroke occurrence rate is gradually increasing and,the age of onset is declining.In clinic,effective prognostic evaluation is significant.The cerebral collateral circulation is subsidiary vascular network after the main vessels failure-caused principal blood flow blockage.Middle cerebral artery(MCA)is the main branch of the internal carotid artery,supporting a wide territory.The severe stenosis or occlusion of MCA often occurs and,the clinical manifestation varies because of the different establishments of collateral circulation.The vascular examinations can be used to detect the location of the thrombus and to evaluate the scale of collateral vasculature.Recent methods to investigate the intracranial circulation condition include transcranial doppler ultrasound(TCD),magnetic resonance angiography(MRA),computer tomography angiography(CTA),and digital subtraction angiography(DSA).The advantages of MRA include short time,nocontrast agent,and presenting the condition of the brain parenchymal,making it a common method for vascular evaluation.Thus,we aimed to explore the association between the posterior cerebral artery(PCA)laterality on MRA and the infarct size,severity and prognosis of stroke with the MCA M1 segment stenosis or occlusion.Methods In this study,161 stroke patients with MCA severe stenosis or occlusion were included successively and prospectively and were divided into PCA laterality positive and negative group from Jan 2010 to Nov 2015.The clinical and imaging data and modified Rankin Scale at 3-month follow-up were compared between the two groups.All statistical data were analyzed by SPSS version 21.0.The continuous statistics were tested by Kolmogorov-Smirnov for normality.Then the normal data were tested using the t-test and Mann-Whitney U test for abnormal data.The category data were tested by ?2 test or Fisher's exact test.Finally,the independent risk factors of 90-day prognosis were defined by the multi-variable Logistic regression analysis.Results Among the 161 patients,76 patients(47.2%)presented PCA laterality(PCAL)positive on MRA while 85 patients(52.8%)presented negative.In the PCAL positive group,the stroke history was more(p = 0.021);DWI-ASPECTS score was higher(p = 0.045);NIHSS score at discharge(p = 0.009)and the 3 months modified Rankin Scale was lower(p = 0.002),respectively.In the Logistic regression analysis,the PCAL positive and the NIHSS score at admission were independent predictors of the prognosis.Conclusion The presence of PCA laterality may suggest the smaller infarction size and the better prognosis of the stroke with MCA severe stenosis or occlusion.