Abstract: Objective To analyze the effect of collateral circulation on long-term prognosis in patients with anterior circulation large vessel occlusion. Methods Patients with non-acute unilateral internal carotid artery (ICA) / middle cerebral artery (MCA) occlusion and receiving aggressive medicine treatment who were admitted in the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled in this retrospective study. The collateral circulation of all the patients were evaluated using American Society of Interventional Neuroradiology (ASITN) / Society of Interventional Radiology (SIR) collateral flow grading system. All the patients were divided into good collateral circulation group (Grade 0-2) and poor collateral circulation group (Grade 3-4). Kaplan-Meier survival curve analysis were used to compare cumulative incidence of recurrent ischemic vascular events and relevant vascular death between

the two groups. Cox regression analysis was used to determine the risk factors for recurrence of

ischemic vascular events. Results Of 302 patients, 222 were in good collateral group and 80 were in poor collateral group. The follow-up time ranged from 2 to 8 years, and the medium follow-up time was 4.0 (3.0-5.0) years. During follow-up, 45 patients (14.9%) had recurrent ischemic vascular events. The 2-year cumulative incidence of ischemic vascular events and mortality in good collateral circulation group were lower than that in poor collateral circulation group (vascular events: 14.3% vs 23.8%, P =0.046; mortality: 4.4% vs 10%, P =0.006, respectively). Cox regression analysis showed that age ≥60 years, history of coronary heart disease, poor collateral circulation (RR 1.86, 95%CI 1.03-4.53, P =0.041), and mRS score >2 points at discharge (RR 3.43, 95%CI 1.69-6.96, P =0.001) were independent risk factors for recurrent ischemic vascular events. Conclusions Patients with non-acute symptomatic ICA/MCA occlusion, especially those with poor collateral circulation, had a high risk of ischemic vascular events recurrence and vascular death within 2 years, even after aggressive medicine treatment. Age ≥60 years, history of coronary heart disease, poor collateral circulation and mRS score >2 points at discharge were independent risk factors for recurrence of ischemic vascular events.

Key words: Cerebral large artery occlusion; Collateral circulation; Aggressive medicine treatment; Prognosis

摘要： 目的 分析侧支循环对非急性期前循环大动脉闭塞患者长期预后的影响，为此类患者临床治疗决 策提供依据。 方法 回顾性收集2009年7月-2015年12月入住西安交通大学第二附属医院接受积极药物治疗的非 急性单侧症状性颈内动脉/大脑中动脉闭塞患者。根据美国介入治疗神经放射学会（American Society of Interventional and Therapeutic Neuroradiology，ASITN）/介入放射学会（Society of Interventional Radiology，SIR）侧支血流分级系统标准评估每位患者的侧支循环情况，分为侧支良好组（ASITN/SIR 分级0～2级）及侧支不良组（ASITN/SIR分级3～4级）。应用Kaplan-Meier生存曲线分析两组患者责任血 管相关缺血性血管事件复发及相关血管性死亡情况；采用Cox回归法分析缺血性血管事件复发的危 险因素。 结果 共纳入302例患者，其中222例为侧支良好组，80例为侧支不良组，随访2～8年，中位随访时 间为4.0（3.0～5.0）年。随访期间，共45例（14.9%）发生了责任血管相关缺血性血管事件复发。侧 支良好组缺血性血管事件2年累积复发率及死亡率均低于侧支不良组（血管事件复发率：14.3% vs 23.8%，P =0.008；死亡率：4.4% vs 10%，P =0.006）。Cox回归分析显示年龄≥60岁、冠心病史、侧 支循环差（RR 1.86，95%CI 1.03～4.53，P =0.041）和出院时mRS>2分（RR 3.43，95%CI 1.69～6.96， P =0.001）是影响责任血管相关缺血性血管事件复发的独立危险因素。 结论 对于非急性症状性单侧颈内/大脑中动脉闭塞患者，尤其侧支循环不良者，即使经过严格的 药物治疗，2年内仍存在较高的缺血性血管事件复发和血管性死亡风险。高龄、冠心病史、侧支循环差 和出院时mRS>2分是其缺血性血管事件复发的独立危险因素。

关键词: 脑大动脉闭塞; 侧支循环; 最佳药物治疗; 预后