关键词:

 , 侧支循环, 急性脑梗死, 神经功能, 预后

Abstract:

Objective To investigate the influence of collateral circulation on curative effects and progno⁃ sis of patients with acute cerebral infarction treated with mechanical thrombectomy. Methods A total of 470 patients （322 with collateral circulation and 148 without collateral circulation）with acute cerebral infarction treated with mechanical thrombectomy between January 1，2015 and November 12，2019 were included in this study. All variables，including admission，14⁃day and 90⁃day NIHSS（National Institutes of Health Stroke Scale）scores， incidence of symptomatic cerebral hemorrhage（sICH），30⁃day mortality，hemodynamic index after operation， peripheral blood HIF ⁃ 1α，VEGF and miRNAs were collected and compared between the groups. Results The scores of admission NIHSS in the collateral circulation group were significantly lower than the non⁃collateral circula⁃ tion group（P＜0.05），but they were not significantly different among the patients with different levels of collateral circulation（P＞0.05）. After treatment，the NIHSS scores of the two groups were significantly lower than at admis⁃ sion（P＜0.05）. The 14⁃day and 90⁃day NIHSS scores of the collateral circulation group were significantly lower than the non⁃collacteral group（P < 0.05），and so it was with the incidence of sICH and 30⁃day mortality（P＜ 0.05）. The average blood flow velocity and average blood flow in the collateral circulation group were significantly higher than the non⁃collateral circulation group（P < 0.05），while the peripheral blood flow resistance was signifi⁃ cantly lower（P < 0.05）. The serum HIF ⁃1α and VEGF in the collateral circulation were significantly lower than the non⁃collateral circulation（P < 0.05）. Peripheral blood mRNA⁃210，mRNA⁃126 and mRNA⁃132 in the collateral circulation were significantly higher than non ⁃collateral circulation，while mRNA ⁃92a was significantly lower（P < 0.05）. Multivariate logistic regression analysis showed mRNA ⁃ 210（OR = 1.452，95% CI：0.949 ~ 2.222，P = 0.025），mRNA⁃126（OR = 2.277，95%CI：1.086 ~ 4.777，P = 0.002），mRNA⁃132（OR = 3.550，95%CI：1.666 ~ 7.565，P = 0.025），mRNA⁃92a（OR = 0.017，95%CI：0.001 ~ 0.325，P = 0.007）were the factors influencing the formation of cerebral collateral circulation in the patients with acute ischemic stroke（P < 0.05）. Conclusions Among patients with acute cerebral infarction treated with mechanical thrombectomy，those with collateral circula⁃ tion have less neurological deficits and better prognosis than those without collateral circulation，and the specific miRNAs in the peripheral blood in the early stage of the disease are important influencing factors for the formation of cerebral collateral circulation.

Key words:

collateral circulation, acute ischemic stroke, neurological function, prognosis