Israeli-korn Simon D, Schwammenthal Yvonne, Yonash-Kimchi Tali, Bakon Mati, Tsabari Rakefet, Orion David, Bruk Bella, Molshatzki Noa, Merzeliak Oleg, Chapman Joab, Tanne David
Stroke Center, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2010 Nov;12(11):671-5.
Multiple case series, mostly highly selected, have demonstrated a very high mortality following acute basilar artery occlusion. The more widespread availability and use of non-invasive vascular imaging over recent years has increased the rate of ABAO diagnosis.
To estimate the proportion of diagnosed ABAO among all-cause ischemic stroke in an era of increasing use of non-invasive vascular imaging and to compare the characteristics and outcomes between these two groups.
We compared 27 consecutive cases of ABAO identified in a university hospital between 2003 and 2007 with 311 unselected cases of ischemic stroke from two 4 month surveys.
ABAO diagnosis increased from 0.3% of all-cause ischemic stroke (2003-2004) to 1.1% (2007), reflecting the increased use of non-invasive vascular imaging. In comparison to all-cause ischemic stroke, ABAO patients were younger (mean age 60 vs. 71 years), were more likely to be male (89% vs. 60%), had less atrial fibrillation (7% vs. 26%), more severe strokes (baseline NIHSS over 20: 52% vs. 12%), higher admission white cell count (12,000 vs. 9000 cells/ mm3), lower admission systolic blood pressure (140 +/- 24 vs. 153 +/- 27 mmHg), higher in-hospital mortality rates (30% vs. 8%) and worse functional outcome (modified Rankin scale < or = 3, 22% vs. 56%) (P< 0.05 for all). Rates of reperfusion therapy for ABAO increased from 0 in 2003-2004 to 60% in 2007.
In this study, ABAO patients represented approximately 1% of all-cause ischemic stroke and were about a decade younger than patients with all-cause ischemic stroke. We report a lower ABAO mortality compared to previous more selected case series; however, most survivors had a poor functional outcome. Given the marked clinical heterogeneity of ABAO, a low threshold for non-invasive vascular imaging with a view to definitive reperfusion treatment is needed.
多个病例系列研究（大多为高度选择性研究）表明，急性基底动脉闭塞后死亡率极高。近年来，非侵入性血管成像技术的应用越来越广泛，这使得急性基底动脉闭塞（ABAO）的诊断率有所提高。
在非侵入性血管成像技术使用日益增加的时代，估计ABAO在所有缺血性卒中病因中所占的比例，并比较这两组患者的特征和预后。
我们将2003年至2007年在一家大学医院连续确诊的27例ABAO患者与通过两次为期4个月的调查选取的311例未选择的缺血性卒中患者进行了比较。
ABAO的诊断率从所有缺血性卒中病因的0.3%（2003 - 2004年）上升至1.1%（2007年），这反映了非侵入性血管成像技术使用的增加。与所有缺血性卒中患者相比，ABAO患者更年轻（平均年龄60岁对71岁），男性比例更高（89%对60%），房颤发生率更低（7%对26%），卒中更严重（基线美国国立卫生研究院卒中量表（NIHSS）超过20分：52%对12%），入院时白细胞计数更高（12,000对9000个/mm³），入院时收缩压更低（140±24对153±27 mmHg），住院死亡率更高（30%对8%），功能预后更差（改良Rankin量表≤3分：22%对56%）（所有比较P<0.05）。ABAO的再灌注治疗率从2003 - 2004年的0%上升至2007年的60%。
在本研究中，ABAO患者约占所有缺血性卒中病因的1%，且比所有缺血性卒中患者年轻约十岁。与之前更多选择性的病例系列研究相比，我们报告的ABAO死亡率更低；然而，大多数幸存者的功能预后较差。鉴于ABAO显著的临床异质性，对于明确的再灌注治疗，需要有较低的非侵入性血管成像检查阈值。
