Correlation Between Collateral Circulation And Prognosis Of Patients With Ischemic Stroke

Objective By using multi-phase CTA combined with CTP to evaluate the leptomeningeal collateral,explore the relationship between the collateral circulation grade and CT perfusion parameters;explore the influence of Lp-PLA2 and other related factors on the formation of collateral circulation;analyze the effect of collateral circulation grade on the prognosis of patients with ischemic stroke.Methods Patients with ischemic stroke who were diagnosed in the Department of Neurology of Chenzhou First People's Hospital within 7days after the onset of the disease and the vessel responsible for the lesion was the middle cerebral artery M1 occlusion were included continuously.Collect general clinical data and improve Lp-PLA2,CRP,HCY,GLU and other examinations,use multi-phase CTA combined with CTP to evaluate the leptomeningeal collateral(at the same time record the blood pressure and time of the examination).On the CTP workstation,the average CBF,CBV,MTT,TTP and area of the core infarction area and ischemic penumbra of the lesion side and mirror side are automatically measured,use“lesion side/mirror side”to get rCBF,rCBV,rMTT,rTTP;with the ASPECTS collateral score scale for multi-phase CTA,Patients with 4-5points of collateral circulation were classified as good group,and patients with 0-3 points of collateral circulation were classified as poor group.(1)Compare the CT perfusion parameters of the core infarction and the ischemic penumbra in the two groups,use Spearman to analyze the correlation between the infarct area and the collateral circulation level,and use ROC curve to find the best CT perfusion parameters to judge good collateral circulation.(2)Compare the differences between Lp-PLA2 and other factors in the two groups,and use Logistic regression analysis to analyze the relationship between each factor and the formation of collateral circulation.(3)The mRS score?2 points after 90 days of onset was judged as a good prognosis;mRS score>2 points was judged as a poor prognosis,compare the difference in good rates between the two groups.ResultsA total of 47 patients were included in this subject,14 in the collateral circulation group and 33 in the collateral circulation group.1.The good collateral circulation group had shorter rTTP and rMTT in the core infarction area compared with the poor collateral circulation group,the difference was statistically significant(P<0.05);the rCBF and rCBV in the core infarction area was no significant difference(P>0.05).The rCBF and rCBV in the ischemic penumbra of the good collateral circulation group were higher than those in the poor collateral circulation group,and the difference was statistically significant(P<0.05);the rTTP and rMTT in the ischemic penumbra was no significant difference(P>0.05).rMTT is the optimal CT perfusion parameter for judging the grade of collateral circulation in the core infarction area,and the corresponding cutoff value is 2.02(AUC=0.761,95%CI(0.609-0.912),P=0.005);rCBF is the best CT perfusion parameter for judging the grade of collateral circulation in the ischemic penumbra.The corresponding cutoff value is 0.599(AUC=0.775,95%CI(0.630-0.920),P=0.003).The grade of collateral circulation was negatively correlated with the area of the core infarct(r=-0.771,P<0.001)and positively correlated with the mismatch rate(r=0.866,P<0.001).2.Lp-PLA2 in the good collateral circulation group was higher than that in the poor group(P<0.05),multivariate Logistic regression analysis:history of diabetes(OR=0.098,95%CI(0.010-0.986),P=0.049),systolic blood pressure at check-up(OR=1.109,95%CI(1.021-1.205),P=0.014),Lp-PLA2(OR=1.031,95%CI(1.010-1.052),P=0.004)related to the state of collateral circulation,however,gender,age,hypertension,smoking history,drinking history,systolic blood pressure at admission,diastolic blood pressure at admission,onset-examination time,diastolic blood pressure at the time of examination,fasting blood glucose,CRP and HCY did not show influence on collateral circulation status(P>0.05).3.The good prognosis rate of the good collateral circulation group was significantly higher than that of the poor group(?~2=9.171,P=0.002).Conclusions1.In CT perfusion parameters,rMTT in the core infarction and rCBF in the ischemic penumbra can determine the collateral circulation status of ischemic brain tissue.2.Lp-PLA2 may be a promoting factor for the well-formed collateral circulation of ischemic stroke;systolic blood pressure is related to the collateral circulation status of ischemic stroke.3.Patients with good collateral circulation have a relatively good clinical prognosis.