Abstract:

Objective: To investigate the predictive value of arterial collateral circulation (ACC), Superficial Venous Drainage Score (SVS) and Deep Venous Drainage Score (DVS) derived from multiphase CTA (mCTA) for 90d neurological function outcome in patients with acute anterior circulation large vessel occlusion (AAC-LVO) ischemic stroke following endovascular treatment (EVT), and to develop predictive models. Methods: Total 148 patients with AAC-LVO ischemic stroke who underwent EVT between April 2020 to March 2025 in Tianjin Huanhu Hospital. All patients underwent mCTA prior to treatment. ACC, SVS and DVS were evaluated based on mCTA. Patients were categorized into good outcome (≤2, n=85) and poor outcome (≥3, n=63) groups based on 90d modified Rankin Scale (mRS) scores. Univariate and multivariate Logistic regression analyses were performed to identify influencing factors for neurological function outcome, based on which prognostic prediction models were established. The predictive efficacy of each model was evaluated using receiver operating characteristic (ROC) curves. Results: Logistic regression analysis showed that poor ACC was an independent risk factor for poor neurological function outcome after EVT in patients with AAC-LVO ischemic stroke (OR=13.601, 95%CI: 1.777-104.105; P=0.012). An high DVS2 score served as an independent protective factor for favorable neurological function outcome (OR=0.019, 95%CI: 0.004-0.094; P=0.000). Three prognostic prediction models were established accordingly. ROC curves showed that area under the curve (AUC) of Model 1 [combining clinical indicators admission National Institutes of Health Stroke Scale (NIHSS) score and ACC] was 0.696 (95%CI: 0.615-0.769, P=0.000). The AUC of Model 2 [combining clinical indicators and venous drainage scores (DVS1, DVS2)] was 0.867 (95%CI: 0.802-0.917, P=0.000). The AUC of Model 3 (combining clinical indicators, ACC and venous drainage scores) was 0.911 (95%CI: 0.854-0.952, P=0.000). Both Model 2 (Z=3.280, P=0.001) and Model 3 (Z=5.731, P=0.000) exhibited significantly better predictive performance for neurological functional prognosis than Model 1, while the predictive efficacy was comparable between Model 2 and Model 3 (Z=1.648, P=0.099). Conclusions: Poor ACC derived from mCTA was a risk factor for poor neurological function outcome after EVT in patients with AAC-LVO ischemic stroke, while a high DVS2 score served as a protective factor for favorable neurological function outcome. The combined model incorporating ACC and venous drainage scores yields favorable predictive performance for long-term neurological function prognosis.

Key words: Arterial occlusive diseases, Carotid artery, internal, Middle cerebral artery, Ischemic stroke, Thrombolytic therapy, Thrombectomy, Prognosis, Collateral circulation, Cerebral veins, Computed tomography angiography

摘要：

目的: 探讨基于多时相CTA（mCTA）的动脉侧支循环、浅静脉引流评分（SVS）和深静脉引流评分（DVS）对急性前循环大血管闭塞致缺血性卒中患者血管内治疗后90d神经功能预后的预测价值，并构建预后预测模型。方法: 纳入2020年4月至2025年3月在天津市环湖医院行血管内治疗的148例急性前循环大血管闭塞致缺血性卒中患者，术前均行mCTA检查，评估动脉侧支循环、SVS和DVS评分；根据术后90d改良Rankin量表分为预后良好组（≤2分，85例）和预后不良组（≥3分，63例），单因素和多因素Logistic回归分析筛查预后影响因素，并据此构建预后预测模型，绘制受试者工作特征（ROC）曲线，比较各模型的预后预测效能。结果: Logistic回归分析显示，动脉侧支循环不良是急性前循环大血管闭塞患者血管内治疗后神经功能预后不良的独立危险因素（OR=13.601，95%CI：1.777~104.105；P=0.012），高DVS2评分是神经功能预后良好的独立保护因素（OR=0.019，95%CI：0.004~0.094；P=0.000）。据此构建3种预后预测模型，ROC曲线显示，包含临床指标（入院时美国国立卫生研究院卒中量表评分）和动脉侧支循环的模型1曲线下面积为0.696（95%CI：0.615~0.769，P=0.000），包含临床指标和静脉引流（DVS1和DVS2评分）的模型2曲线下面积为0.867（95%CI：0.802~0.917，P=0.000），包含临床指标、动脉侧支循环和静脉引流的模型3曲线下面积为0.911（95%CI：0.854~0.952，P=0.000）；模型2（Z=3.280，P=0.001）和模型3（Z=5.731，P=0.000）对神经功能预后的预测效能均优于模型1，二者预测效能相当（Z=1.648，P=0.099）。结论: 基于mCTA的动脉侧支循环不良是急性前循环大血管闭塞患者血管内治疗后神经功能预后不良的危险因素，高DVS2评分是神经功能预后良好的保护因素，联合动脉侧支循环与静脉引流评分的预测模型具有较高的预后预测价值。

关键词: 动脉闭塞性疾病, 颈内动脉, 大脑中动脉, 缺血性卒中, 血栓溶解疗法, 血栓切除术, 预后, 侧支循环, 脑静脉, 计算机体层摄影血管造影术

CLC Number: 

• R741