Department of Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.
Stroke. 2011 Jul;42(7):1946-51. doi: 10.1161/STROKEAHA.110.606038. Epub 2011 May 5.
Intra-arterial thrombolysis can be used for treatment of basilar artery occlusion. Predictors of outcome before initiation of treatment are of special interest.
From 1992 to 2010, we treated 106 consecutive patients with basilar artery occlusion with intra-arterial thrombolysis. Baseline characteristics, treatment, clinical course, and 3-month and long-term outcomes (≥12 months) were assessed. Outcome parameters were vessel recanalization after treatment, complications, modified Rankin scale (mRS) score, and mortality after 3 months and in the long-term.
At 3 months, clinical outcome was good (mRS score, 0-2) in 33.0% of the patients and moderate (mRS score, 3) in 11.3%. Mortality was 40.6%. Partial or complete recanalization was achieved in 69.8% of the patients, and symptomatic intracranial hemorrhage occurred in 1 patient (0.9%). Between 3-month and long-term follow-up, 22 survivors (40.8%) showed clinical improvement of at least 1 point on the mRS score, 29 (53.7%) were functionally unchanged, and 3 (5.7%) showed functional worsening (P<0.0001). Multivariate analysis identified diabetes as a predictor of poor vessel recanalization (P=0.028). Low baseline National Institutes of Health Stroke Scale score was identified as a predictor of good or moderate clinical outcome (P<0.0001) and survival (P=0.001) at 3 months, and younger age was identified as an additional predictor of survival (P=0.012). For prediction of long-term clinical outcome, age was also an independent predictor (P=0.018).
In our series, intra-arterial thrombolysis as treatment of basilar artery occlusion was safe. National Institutes of Health Stroke Scale score at admission and age were identified as predictors of outcome, and these predictors should be considered for treatment allocation in future randomized trials.
动脉内溶栓可用于治疗基底动脉闭塞。治疗前的预后预测因素特别值得关注。
1992 年至 2010 年，我们对 106 例连续基底动脉闭塞患者进行了动脉内溶栓治疗。评估了基线特征、治疗、临床过程以及 3 个月和长期结局（≥12 个月）。结局参数包括治疗后血管再通、并发症、改良 Rankin 量表（mRS）评分以及 3 个月和长期死亡率。
3 个月时，33.0%的患者临床结局良好（mRS 评分 0-2），11.3%的患者结局中等（mRS 评分 3）。死亡率为 40.6%。69.8%的患者实现了部分或完全再通，1 例患者发生症状性颅内出血（0.9%）。在 3 个月至长期随访期间，22 名幸存者（40.8%）的 mRS 评分至少提高了 1 分，29 名（53.7%）无功能变化，3 名（5.7%）功能恶化（P<0.0001）。多变量分析确定糖尿病是血管再通不良的预测因素（P=0.028）。较低的基线国立卫生研究院卒中量表评分被确定为 3 个月时良好或中等临床结局（P<0.0001）和生存（P=0.001）的预测因素，而年龄较小则被确定为生存的附加预测因素（P=0.012）。对于长期临床结局的预测，年龄也是一个独立的预测因素（P=0.018）。
在我们的研究中，动脉内溶栓作为基底动脉闭塞的治疗是安全的。入院时国立卫生研究院卒中量表评分和年龄被确定为结局的预测因素，这些预测因素应在未来的随机试验中考虑用于治疗分配。
