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目的:以脑血管造影侧支循环作为评估急性大血管闭塞所致缺血性卒中(acute ischemic stroke due to large vessel occlusion, AIS-LVO)发病后6～24 h行血管内血栓切除术(endovascular thrombectomy, EVT)的筛选方法，比较其与灌注加权成像(perfusion-weighted imaging, PWI)-弥散加权成像(diffusion-weighted imaging, DWI)不匹配方法的有效性以及安全性。方法:回顾性纳入福建省立医院神经内科2019年1月至2020年5月期间在发病后6～24 h接受EVT治疗的AIS-LVO患者。根据EVT筛选方法，将患者分为侧支循环筛选组和PWI-DWI筛选组。侧支循环筛选组为术前没有条件行脑灌注检查，基于数字减影血管造影(digital subtraction angiography, DSA) ASITN/SIR标准选取分级为2～4级的侧支循环良好患者；PWI-DWI筛选组为术前行PWI＋DWI检查，通过PWI-DWI不匹配选取存在缺血半暗带的患者。通过术后出血性转化以及有症状颅内出血发生率评估其安全性，通过术后90 d改良Rankin量表评分明确其作为评估方法的有效性，>2分定义为转归不良。结果:共纳入在发病后6～24 h接受EVT治疗的AIS-LVO患者61例，年龄(68.15±6.98)岁，男性39例(63.9%)，基线美国国立卫生研究院卒中量表评分(20.33±7.84)分。侧支循环筛选组37例(60.7%)，PWI-DWI筛选组24例(39.3%)。术后90 d时转归良好35例(57.4%)，转归不良26例(42.6%)。侧支循环筛选组与PWI-DWI筛选组人口统计学、血管危险因素、基线临床资料、发病至EVT时间、尝试取栓次数、血管成功再通率、出血性转化和有症状颅内出血发生率以及90 d时临床转归均差异无统计学意义。多变量n logistic回归分析显示，中重度卒中(基线美国国立卫生研究院卒中量表评分16～20分：优势比11.649，95%可信区间3.396～39.962；n P2 was defined as poor outcome.Results:A total of 61 patients with AIS-LVO treated with EVT 6-24 h after onset were enrolled in the study. Their age was 68.15±6.98 years, 39 were male (63.9%), and the baseline National Institutes of Health Stroke Scale (NIHSS) score was 20.33±7.84. There were 37 patients (60.7%) in collateral circulation screening group and 24 (39.3%) in PDM screening group. At 90 d after operation, 35 patients (57.4%) had a good outcome and 26 (42.6%) had a poor outcome. There were no statistically significant differences in demographics, vascular risk factors, baseline clinical data, the time from onset to EVT, number of thrombectomy attempts, successful recanalization rate, incidence of hemorrhagic transformation and sICH, and clinical outcome at 90 d between the two groups. Multivariate n logistic regression analysis showed that moderate to severe stroke (baseline NIHSS score 16-20: odds ratio 11.649, 95% confidence interval 3.396-39.962; n P<0.001) and the number of thrombectomy ≥3 times (odds ratio 3.314; 95% confidence interval 1.011-10.867;n P=0.048) were independently associated with poor outcomes.n Conclusion:For patients with AIS-LVO 6 to 24 h after the onset, if perfusion-and diffusion-weighted imaging could not be performed, patients with good collateral circulation could be screened for EVT treatment according to the collateral circulation of cerebral angiography, and its evaluation effect was equivalent to that of PDM.