Department of Radiology, Shinbeppu Hospital, 874-0833, Tsurumi 3898, Beppu, Oita, Japan.
Neuroradiology. 2010 May;52(5):361-70. doi: 10.1007/s00234-010-0658-9. Epub 2010 Jan 30.
Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported.
Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated.
Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0-2], and the other 11 had poor outcomes (mRS 3-6). Five of six patients who scored 9-14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3-8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site.
Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization.
椎基底动脉闭塞（VBO）的血管再通率低，因此接受血管内治疗的死亡率和发病率均较高。本研究旨在探讨经皮腔内血管成形术（PTA）在局部动脉内溶栓（LIF）基础上对提高血管再通率的作用。本文报告了急性颅内 VBO 血管再通治疗后的结果。
2000 年 8 月至 2006 年 5 月，18 例急性 VBO 患者接受了 LIF 联合或不联合 PTA 治疗。8 例患者单独接受 LIF 治疗，10 例患者需要额外的 PTA。评估血管再通率、治疗前的神经状态和临床结果。
18 例患者中，17 例实现了血管再通。1 例发生与操作相关的蛛网膜下腔出血并发症。出院时总存活率为 94.4%。7 例患者获得良好结局（改良 Rankin 量表[mRS]0-2），11 例患者结局较差（mRS 3-6）。治疗前格拉斯哥昏迷量表（GCS）评分 9-14 的 6 例患者中，5 例预后良好，而 GCS 评分 3-8 的 12 例患者中，10 例预后较差。治疗前 GCS 与结局呈显著相关（p < 0.05）。此外，治疗前 NIHSS 与 mRS 相关性良好（相关系数 0.487）。两组患者在症状持续时间、年龄、病因和闭塞部位方面无统计学差异。
血管内再通可降低急性 VBO 的死亡率和发病率。治疗前良好的 GCS 和 NIHSS 评分可预测血管内再通的疗效。
