Effect of collateral circulation status on the neurological function and clinical outcome in acute ischemic stroke patients with intravenous thrombolysis / 中国脑血管病杂志

ABSTRACT

Objective To study the effect of different collateral circulation on the neurological function and clinical outcome in acute ischemic stroke patients with intravenous thrombolysis, and explore the relationship of the sub item of National Institute of Health stroke scale (NIHSS) with collateral circulation status. Methods From December 2016 to April 2019, 73 consecutive patients with severe stenosis and occlusion of middle cerebral artery (Ml segment) who underwent intravenous thrombolysis at the Department of Neurology, The First Affiliated Hospital of Xinxiang Medical College were retrospectively recruited. The target patients were selected according to CT angiography (CTA) - CT perfusion (CTP) and the collateral circulation status was evaluated before intravenous thrombolysis. The patients were divided into the good collateral circulation group and the poor collateral circulation group. Clinical data were collected and the NIHSS score was used to assess the neurological deficit. The modified Ranking scale (mRS) was used to assess the prognosis of 90 days after onset. The clinical data of the two groups were compared to investigate the relationship between collateral circulation status and NIHSS score sub-items at admission by univariate and multivariate Logistic regression analysis. Also, the relationship between collateral circulation before thrombolysis and clinical outcome after thrombolysis was studied (The primary outcome: mRS score 0 -1 at 90 d; the secondary outcomes: early neurological function significant improvement [NIHSS score 0-1 at 72 h after treatment, or 8 points lower than baseline NIHSS score] and mRS score 0-2 at 90 d after onset; the safety outcome: cerebral hemorrhagic transformation and death 90 days after onset). Results Among the 73 patients, 43 patients were in the good collateral circulation group and 30 patients were in the poor collateral circulation group. The NIHSS scores at admission and 72 hours after treatment in the good collateral circulation group were lower than those in the poor collateral circulation group(2.00 [1.00, 5.00] score vs. 7.00[3.75, 10. 00]score, 1. 00[0. 00, 3. 00]score vs. 5. 00[1. 75, 6. 25]score, respectively; all P <0. 01). Single factor Logistic regression analysis showed that, the scores of facial paralysis, upper limb movement, lower limb movement, dysarthria in the poor collateral circulation group were more than those in the good collateral circulation group(OR and 95%CI, 5.058[2. 249 -11. 372], 1.465[1. 024-2. 094], 1. 633[1. 069 -2. 495], 2. 669 [1. 072 -6. 647], all P < 0. 05). For the primary outcome, 67.4% (29/43) of patients with good collateral circulation and 40. 0% (12/30) of patients with poor collateral circulation had a mRS score of 0-1 (OR, 1.686, 95% CI 1. 068 -3. 105, P = 0. 020). For the secondary outcomes, early neurological improvement was achieved in 53. 5% (23/43) of patients with good collateral circulation and 20.0% (6/30) in patients with poor collateral circulation (OR, 2. 672, 95% CI 1. 241 -5. 765, P = 0.004); the mRS score 0-2 was obtained in 86.0% (37/43) of patients with good collateral circulation and 63. 3% (19/30) of patients with poor collateral circulation (OR, 1. 359, 95% CI 1. 009-1.830, P = 0.024). For the safety outcome, 2 patients in the good collateral circulation group and 7 patients in the poor collateral circulation group had hemorrhagic transformation (OR, 0. 199, 95% CI 0. 044 - 0. 894, P = 0.043); there was no significant difference in mortality risk between the two groups (OR, 0. 698, 95% CI 0. 104 -4. 682, P = 1. 000). Conclusions For acute ischemic stroke patients with middle cerebral artery severe stenosis and occlusion, good collateral circulation is associated with mild clinical symptoms. The increased scores of the facial paralysis, upper limb movement, lower limb movement, dysarthria in NIHSS score sub-item could reflect the poor collateral circulation. Good collateral circulation is conducive to early improvement of neurological function and favorable prognosis in patients with intravenous thrombolysis. It may reduce the risk of hemorrhagic transformation but not the risk of death.