Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA.
J Neurosurg. 2012 May;116(5):952-60. doi: 10.3171/2012.1.JNS11997. Epub 2012 Feb 3.
The treatment of acute intracranial vertebrobasilar artery occlusion (VBO) has been described but often with poor results. The authors of this study set out to evaluate their institution's outcomes following multimodal treatment of VBO.
They retrospectively reviewed their endovascular database for all patients treated for acute intracranial VBO between December 2004 and June 2010. Twenty-four patients were identified. Two patients were excluded from evaluation-one because of incomplete medical records and one because the etiology was basilar stenosis and not stroke. Occlusion location, hypercoagulable causes, time to endovascular treatment, time to revascularization, comorbidities, devices used, procedural anticoagulation, and outcomes were analyzed.
Among the 22 eligible study patients, the mean National Institutes of Health Stroke Scale (NIHSS) score at presentation was 15.3. The mean time from presentation to initiation of the endovascular procedure was 4.77 hours. The mean time for recanalization from the start of angiography was 1.63 hours. In 16 patients (73%), revascularization was successful (Thrombolysis in Myocardial Infarction [TIMI] score of 2 or 3). Thirteen (59%) of the 22 patients were discharged to home or a rehabilitation facility. One patient was transferred to a chronic care facility. The overall survival rate was 64%. The average NIHSS score for the 14 surviving patients at discharge was 3.9. At the follow-up (average 14.5 months, range 1-58 months), 10 patients (71%) had achieved good outcomes (modified Rankin Scale [mRS] score ≤ 2) and 4 (29%) had poor outcomes (mRS Score 3-6).
Published case series have historically shown poor outcomes and high mortality rates in association with the treatment of acute VBO, prompting surgeons to be less aggressive in the treatment of this disease than they might be otherwise. Data in this series show that the revascularization of posterior circulation occlusions is feasible and that good outcomes and lower mortality rates with newer endovascular technologies are possible, and thus more prompt and aggressive treatment of this disease may be warranted.
急性颅内椎基底动脉闭塞（VBO）的治疗已有描述，但结果往往不佳。本研究的作者旨在评估他们机构对 VBO 进行多模式治疗后的结果。
他们回顾性地查看了 2004 年 12 月至 2010 年 6 月期间所有接受急性颅内 VBO 治疗的血管内数据库。共确定了 24 名患者。有两名患者因医疗记录不完整和病因是基底狭窄而不是中风而被排除在评估之外。分析了闭塞部位、高凝原因、血管内治疗时间、再血管化时间、合并症、使用的设备、程序抗凝和结果。
在 22 名符合条件的研究患者中，发病时的平均国立卫生研究院卒中量表（NIHSS）评分为 15.3。从发病到开始血管内手术的平均时间为 4.77 小时。从血管造影开始到再通的平均时间为 1.63 小时。在 16 名患者（73%）中，再通成功（血栓溶解心肌梗死 [TIMI]评分 2 或 3）。22 名患者中有 13 名（59%）出院回家或康复设施。一名患者转至慢性病护理机构。总的存活率为 64%。14 名存活患者出院时的平均 NIHSS 评分为 3.9。在随访（平均 14.5 个月，范围 1-58 个月）时，10 名患者（71%）取得了良好的结局（改良 Rankin 量表[mRS]评分≤2），4 名患者（29%）结局较差（mRS 评分 3-6）。
既往发表的病例系列研究表明，急性 VBO 治疗的结果较差，死亡率较高，促使外科医生在治疗这种疾病时不如其他疾病那样积极。本系列数据表明，后循环闭塞的再通是可行的，并且使用新的血管内技术可以取得良好的结局和较低的死亡率，因此可能需要更及时和更积极地治疗这种疾病。
