Evaluation Of Collateral Circulation And Intravascular Treatment Outcomes In Acute Ischemic Stroke By Multimodal Computer Tomography

Objective:Multimodal CT was used to predict the collateral status and clinical outcome of patients with acute ischemic stroke beyond the time window,to explore the strong predictors in baseline clinical and imaging data,and to screen out patients suitable for endovascular treatment in a short time,so as to guide clinicians to choose treatment options.Methods:A total of 46 patients were collected in the Department of Neurology,First Hospital of Jilin University from July 2017 to October2020 diagnosed with acute ischemic stroke,and received endovascular interventional treatment within 6-24 h of onset.All patients were confirmed by CTA or DSA examination only unilateral middle cerebral artery M1 segment occlusion ± the ipsilateral internal carotid artery in patients with partial occlusion,preoperative accept multimodal CT examination.We collected clinical data,including the age,sex,blood glucose,blood pressure,triglycerides,homocysteine,low density lipoprotein,cholesterol,smoking history,drinking history,history of cerebral infarction,baseline NHISS,recanalization NIHSS score within24 h after treatment,the imaging time,endovascular treatment time,90 days m RS score,and Imaging data,including CT-Aspects score,CTP-Aspects score,CTA regional leptomeningeal score and postoperative infarct volume.The imaging data were evaluated by two radiologists according to the evaluation principles,and in case of disagreement,it was resolved by a third physician through consultation.We used the NHISS score and 90-day m RS scores to evaluate the short-term and long-term outcomes of patients with acute ischemic stroke beyond the time window.We used SPSS software for data statistical analysis.Results:(1)When we compared the baseline clinical and imaging data of the good and bad collateral groups,the univariate results showed statistical differences in smoking history,CBV-aspects,CBF-aspects,90-day m RS scores,final infarct volume.Our study found that patients with poor collateral collateral had a higher proportion of smoking history(78.9%),higher CBV-Aspects and CBF-Aspects scores,and patients with poor collateral collateral were more likely to have a 90-day poor prognosis(68.4%)and a larger infarct volume(144.33 ml).(2)Multivariate results showed that CBV-ASPECTS(OR =0.240,95%CI :0.079～0.734,P =0.012)and smoking history(OR =7.829,95%CI :1.396～43.905,P=0.019)are independent influencing factors for predicting the state of collateral.(3)Comparison of clinical imaging data between the group with good recent clinical outcomes and the group with poor recent clinical outcomes of patients beyond time window showed statistically significant differences in collateral scores and CBV-aspects by univariate results,P<0.05;Multivariate analysis showed that only collateral score entered the regression equation,and the collateral score in the good prognosis group(16.58±2.75)was significantly higher than that in the poor collateral score group(12.97±3.35),and the corresponding curve area of collateral score was 0.822(P < 0.05).(4)Comparison of patients with good long-term prognosis and patients with poor long-term prognosis,univariate results showed statistically significant differences in collateral score,NHISS scores and CBV-Aspects scores(P <0.05).Multivariate results showed that the collateral score and NHISS score entered the regression equation.The collateral score of the group with good long-term prognosis(15.43±3.06)was significantly higher than that of the group with poor prognosis(13.41±3.56).The baseline NHISS score of the group with good prognosis(11.35±3.31)was lower than that of the group with poor prognosis(14.35±3.55).According to ROC curve analysis,the areas under the collateral score and baseline NHISS score curves were 0.742 and 0.740,respectively,and these areas were similar.The size comparison is that the area under the collateral score curve is larger.The thresholds of baseline NHISS score and r LMC score were12.5 and 15.5,respectively.Conclusion:1、CBV-aspects and smoking history were independent factors for predicting collateral status in patients with acute ischemic stroke.2、Collateral status is an independent predictor of short-term and long-term outcomes in patients with acute ischemic stroke beyond the time window,and baseline NHISS score is an independent predictor of long-term outcomes.3、 r LMC score≥15.5 and baseline NHISS score ≥12.5 can be used to indicate good long-term clinical outcome.4、Multimodal CT examination has a certain predictive effect on the collateral circulation and prognosis of acute ischemic stroke patients beyond the time window,and can be used to preliminarily screen patients beyond the time window for endovascular treatment.