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目的:探讨基于四维CT血管造影（4D CTA）的侧支循环评分及血栓负荷评分对大梗死核心前循环急性缺血性卒中（AIS）患者行血管内治疗预后的预测价值。方法:回顾性纳入2016年3月至2020年9月在北京医院行血管内治疗的大梗死核心（梗死核心≥50.0 ml）前循环AIS患者36例，其中改良Rankin量表（mRS）评分0~2分者10例（27.8%，预后良好组），3~6分者26例（72.2%，预后不良组）。采用Mann-Whitney n U及Fisher检验分析两组4D CTA侧支循环评分、血栓负荷评分及基线临床数据的差异，多因素logistic回归分析患者预后不良（mRS评分3~6分）及死亡相关的危险因素。基于90 d的临床结果，使用受试者工作特征（ROC）曲线评估梗死核心体积的区分能力，分别获得预后不良（mRS评分3~6分）和死亡的梗死核心体积的截断值。n 结果:预后不良组患者年龄更大［81.0（72.8，85.0）比66.0（59.0，80.0）岁，n Z=-2.19，n P=0.028］、血糖水平更高［8.2（6.7，10.8）比5.6（4.8，7.9）mmol/L，n Z=-2.38，n P=0.017］、4D CTA侧支循环评分和血栓负荷评分更低［1.0（0，2.0）比3.0（2.8，3.0）分，n Z=-3.41，n P=0.001；3.0（0，6.0）比7.0（6.0，9.0）分，n Z=-3.03，n P=0.002］、梗死核心体积更大［95.8（68.9，152.6）比55.2（50.9，69.8）ml，n Z=-3.03，n P=0.001］、出血转化和脑疝发生率更高［23（88.5%）比1例（1/10），n P<0.001；9（34.6%）比0例（0），n P=0.039］。多因素回归分析显示，基于4D CTA的不良侧支循环评分（n OR=0.18，95%n CI：0.03~0.99，n P<0.05）与血栓负荷评分（n OR=0.64，95%n CI：0.44~0.93，n P<0.05）是预后不良的独立预测因子。通过ROC曲线获得区分预后良好及预后不良的梗死核心体积截断值为63.7 ml；区分死亡与生存的截断值为130.3 ml。n 结论:对于前循环大血管闭塞的大梗死核心AIS患者，具有良好的4D CTA侧支循环评分及高血栓负荷评分的患者可能受益于血管内治疗。“,”Objective:To assess the prognostic value of the collateral status and clot burden score based on four-dimensional computed tomography angiography(4D CTA)in anteriorcir culation is chemics troke patients with large ischemic core after endovascular treatment.Methods:Clinical and imaging data of 36 anterior circulation ischemic stroke patients with large infarct core (infarct core≥50.0 ml) after endovascular treatment at our institution from March 2016 to September 2020 were retrospectively reviewed. According to the modified Rankin Scale (mRS) score, patients were divided into the good outcome (mRS score 0-2) and poor outcome (mRS score 3-6) groups. Mann-Whitney n U and Fisher tests were used to compare the 4D CTA collateral circulation score, clot burden score, and baseline clinical data between the good and poor outcome groups. Multivariate logistic regression was used to analyze the risk factors associated with the poor outcome (mRS score 3-6) and mortality in patients with large infarct core stroke. Finally, based on the 90-day outcome, a ROC curve was used to obtain the cut-off values for poor prognosis (mRS 3-6) and death, respectively.n Results:Ten patients (27.8%) had good outcome and 26 (72.2%) had poor outcome. The patients in the poor outcome group had older median age, higher blood glucose, lower 4D CTA collateral circulation score, lower clot burden score, larger infarct core volume, and higher hemorrhagic transformation and brain hernia (all n P<0.05). Multivariate logistic regression showed that the poor collateral circulation score on 4D CTA(n OR=0.18, 95%n CI: 0.03-0.99, n P<0.05)and clot burden score(n OR=0.64, 95%n CI: 0.44-0.93, n P<0.05) were independent predictors of the poor prognosis. The ROC curves revealed that the cut-off value of infarct core for distinguishing between good prognosis and poor prognosis was 63.7 ml, while that for distinguishing between survival and death was 130.3 ml.n Conclusions:Endovascular treatment may improve the prognosis of patients with large infarct core of anterior circulation is chemic stroke if the patients have good 4D CTA collateral circulation score and high clot burden score.