| Objective The influencing factors of collateral circulation in patients with cardiogenic embolism were analyzed to explore the relationship between collateral circulation and prognosis.Methods Patients with cardiogenic cerebral embolism who were admitted to Hangzhou First People's Hospital affiliated to Zhejiang University School of Medicine for endovascular treatment(EVT)from October 2007 to March 2020 were retrospectively analyzed.The open level of collateral circulation was evaluated according to the results of cerebral angiography(DSA),and the ASTIN/SIR scoring method was used to evaluate the collateral circulation.Grade 0-2 was considered as bad collateral,and grade 3-4 was considered as good collateral.Patients were divided into good collateral group(n=72)and bad collateral group(n=93).Short-term outcomes were assessed by the National Institutes of Health Stroke Scale(NIHSS)at 1 and 7 days postoperatively,and functional outcomes were assessed by modified Rankin score(mRS)at 90 days of onset.Univariate and logistic regression analysis was used to analyze the relationship between gender,age,smoking,history of hypertension,diabetes,coronary heart disease,preoperative and postoperative NIHSS scores and collateral circulation.Results 1.Among the 165 patients,72 were in the good collateral group,93 were in the bad collateral group,60 were in the vein thrombolytic bridging and 105 were in the simple artery thrombectomy.Compared with the good collateral group,the adverse collateral group had higher preoperative NIHSS score,NIHSS score 1 day after surgery,NIHSS score 7 days after surgery,mRS score 90 days after surgery,and higher proportion of smoking history and coronary heart disease history.There were no significant differences between the two groups in age,gender,baseline systolic,blood pressure,baseline diastolic blood pressure,history of hypertension,history of diabetes,creatinine,uric acid,fasting blood glucose,triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,C-reactive protein,homocysteine(P>0.05).2.The difference of occluded vessel sites between the group with good collateral and the group with poor collateral was statistically significant(P<0.05).The M1 segment embolization of middle cerebral artery was more common in the group with good collateral,while internal carotid artery embolization was more common in the group with poor collateral.3.Comparison of indicators for evaluation of short-term efficacy after intracranial artery thrombectomy:the incidences of bleeding transformation(HT)and symptomatic bleeding transformation(sICH)in the good collateral group and the bad collateral group were counted,and the NIHSS scores were calculated at 1 day and 7 days after operation.The difference in NIHSS scores between the two groups at 1 and 7 days postoperatively was statistically significant(P<0.05).The incidence of HT was 44.4%in the group with good collateral,46.2%in the group with poor collateral,9.7%in the group with good collateral,8.6%in the group with poor collateral,and the incidence of pulmonary infection was 72.2%in the group with good collateral,and 75.3%in the group with poor collateral.There was no statistical difference in the risk of HT,SICH and pulmonary infection between the two groups(P>0.05).4.Multivariate Logistic analysis showed that smoking was an independent risk factor for adverse collateral(OR=2.310,95%CI:1.090-4.896,P=0.029).5.Comparison of clinical characteristics between the good and poor outcomes group showed that a history of hypertension,pulmonary infection,lower blood flow grade,poor collateral,higher admission,and NIHSS scores at 1 and 7 days postoperatively were associated with poor outcomes(P<0.05).There was no statistical difference in bleeding type and bridging treatment between the two groups(P>0.05).Conclusions 1.Smoking and coronary heart disease are associated with the formation of adverse collateral in patients with cardiogenic cerebral embolism,and smoking is an independent risk factor for the formation of adverse collateral.2.In patients with cardiogenic cerebral embolism,M1 segment embolism of middle cerebral artery was more common in patients with good collateral branches,while internal carotid artery embolism was more common in patients with poor collateral branches.3.Patients with adverse collateral had poor short-term prognosis and functional outcome at 3 months after EVT treatment.4.The poor prognosis after EVT treatment in patients with cardiogenic embolism was associated with history of hypertension,pulmonary infection,lower blood flow grade,poor collateral,higher admission,and NIHSS scores at 1 and 7 days after surgery,and the NIHSS score at 7 days after operation is an independent risk factor for adverse prognosis... |
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