动态CT血管造影评估急性基底动脉闭塞患者侧支血流与再灌注治疗预后的关系

目的：研究动态CT血管造影对急性基底动脉闭塞所致缺血性卒中患者侧支血流状态评估以及预测再灌注治疗后结局的价值。方法：回顾性分析2012年1月至2016年8月在浙江大学医学院附属第二医院接受再灌注治疗的45例急性基底动脉闭塞所致缺血性卒中患者的临床资料。采用单因素和二元logistic回归模型分析患者预后的独立预测因素，并采用受试者工作特征（ROC）曲线确定预测患者预后的后循环侧支评分（PC-CS）的最佳阈值。结果：二元logistic回归分析提示，基线美国国立卫生研究院卒中量表（NIHSS）评分（OR=0.886，95%CI：0.802~0.979，P<0.05）和PC-CS（OR=1.962，95%CI：1.026~3.752，P<0.05）是患者预后的独立预测因素，且PC-CS 4.5分是预测患者预后的最佳阈值（AUC=0.837，敏感度为68.2%，特异度为87.0%）。结论：基于CT灌注成像重建的动态CT血管造影可用于评估后循环侧支血流状态，并能预测急性基底动脉闭塞所致缺血性卒中患者再灌注治疗后的临床结局。
Abstract: Objective:To evaluate the collateral flow in patients with ischemic stroke due to acute basilar artery occlusion by dynamic CT angiography and to predict the outcome after reperfusion therapy. Methods:Forty-five patients with stroke due to acute basilar artery occlusion undergoing reperfusion treatment in the Second Affiliated Hospital of Zhejiang University School of Medicine during January 2012 and August 2016 were retrospectively reviewed. Univariate and binary logistic regression model were used to identify the independent predictors of patient's outcome, and the receiver operating characteristic (ROC) curve was used to determine the optimal threshold of the posterior circulation collateral score (PC-CS) in predicting the prognosis of the patients. Results:Binary logistic regression analysis indicated that the baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=0.886, 95% CI:0.802-0.979, P<0.05) and PC-CS (OR=1.962, 95%CI:1.026-3.752, P<0.05) were independent predictors of patient's outcome, and PC-CS 4.5 was the optimal threshold (AUC:0.837, sensitivity of 68.2%, specificity of 87.0%). Conclusion:Dynamic CT angiography based on CT perfusion imaging can be used to evaluate collaterals in posterior circulation, and to predict clinical outcome after reperfusion therapy in patients with acute basilar artery occlusion. Key words: Basilar artery Collateral circulation Reperfusion Arterial occlusive diseases/drug therapy Stroke/drug therapy Hemodynamics Angiography, digital subtraction Tomography, X-ray computed/methods Thrombolytic therapy/methods Prognosis