Effect of collateral circulation on prognoses of patients with acute cerebral ischemia after thrombolysis

Abstract

Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation. Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1, 2014 and February 1, 2016. Patients were divided into good collaterals group (n=31) and poor collaterals group (n=18) according to their distribution of leptomeningeal arteries with CTA. Thirty day mortality rate, the incidence of symptomatic intracranial hemorrhage, 24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups. Corrected chi-squared test, Fisher’s exact test, or t test was used to statistical analysis as appropriate. Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0% vs. 16.7%, P 0.05), however, 30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2±3.1 vs. 9.6±2.7, P<0.05). Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis, good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis. However, good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients. Key words: Retrospective studies; Middle cerebral artery occlusion; Recombinant tissue plasminogen activator; Collateral circulation; Computed tomography angiography; National Institute of Health Stroke Scale; Symptomatic cerebral hemorrhage; Mortality