Relationship between collateral circulation and degree of neurological deficit and prognosis in patients with severe posterior circulation stenosis or occlusion： a retrospective case series study

Abstract

Objective To investigate the relationship between compensatory collateral circulation and the degree of neurological deficit and proaosis in patients with severe posterior circulation stenosis or occlusion. Methods Posterior circulation severe stenosis or occlusion caused ischemic stroke patients were enrolled retrospectively. The compensatory collateral circulation in intracranial artery was assessed by using cranial Doppler and eerebrovaseular zging techniques. The patients were divided into either an adequate compensatory collateral circulation group or an inadequate compensatory collateral circulation group. The ader, age, past medical history, blood biochercal indexers, baseline National Institutes of Hea,th Stroke Sc.ate （NIHSS） score and the modified Rankin tle （mRS） score at 3 months after symptom onset in both groups were compared and analyzed, Results A total of 76 patients with severe posterior circulation stenosis or occlusion caused ischemic stroke were enrolled in the study. There were 35 patients in the adequate compensatory collateral circulationgroup and 41 in the inadequate compensatory collateral circulation group. The levels of high sensitive C-reactive protein （hs-CRP） （20. 92 ± 31.97 mg/L vs. 4. 172 ± 4. 268 rag/L; t = 2. 983, P = 0. 004） and low-density lipoprotein cholesterol （1. 272 ±0. 835 mmol/L vs. 1. 096 ± 0. 301 mmol/L; t = 2. 520, P = 0. 014） were significantly higher than those in the adequate compensatory collateral circulation group. Multivariate logistic regression analysis showed that only the increased hs-CRP level was the independent risk factor for inadequate collateral circulation in patients with severe posterior circulation stenosis or occlusion （odds ratio 1. 513, 95% confidence interval 1. 218 - 1. 880; P 〈 0. 001 ）. The baseline NIHSS score （Z = 3. 161, P 〈 0. 001 ） in the adequate compensatory collateral circulation group and mRS score （Z = 3. 143, P 〈 0. 001） at 3 months were significantly lower than that in the inadequate compensatory collateral circulation group. Conclusions The increased CRP level is an independent risk factor for inadequate compensatory of collateral circulation during the severe posterior circulation stenosis or occlusion. The establishment of adequate collateral circulation in patients with severe stenosis or occlusion has mild neurological deficit and the prognosis is better. Key words: Collateral Circulation; Brain Ischemia; Vertebrobasilar Insufficiency; Risk Factors; C-Reactive Protein; Severity of Illness Index; Pro~aosis