Department of Neurology, University of Helsinki, Helsinki, Finland.
Ann Neurol. 2013 Jun;73(6):688-94. doi: 10.1002/ana.23904. Epub 2013 Jul 8.
To evaluate the impact of extensive baseline ischemic changes on functional outcome after thrombolysis of basilar artery occlusion (BAO), and to study the effect of time to treatment in the absence of such findings.
We prospectively evaluated 184 consecutive patients with angiography-proven BAO. The majority of patients received intravenous alteplase and concomitant full-dose heparin. Extensive baseline ischemia was defined as posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) < 8. Onset-to-treatment time (OTT) was evaluated both as a continuous and as a categorical variable (0-6 hours, 6-12 hours, 12-24 hours, and 24-48 hours). Successful recanalization means thrombolysis in myocardial infarction (TIMI) = 2 to 3. Symptomatic intracranial hemorrhage (sICH) was evaluated with National Institute of Neurological Disorders and Stroke, European Cooperative Acute Stroke Study II, and Safe Implementation of Thrombolysis in Stroke criteria. Poor 3-month outcome was defined as modified Rankin Scale score of 3 to 6.
The majority (96%) of patients with baseline pc-ASPECTS < 8 had poor 3-month outcome, and a similar number (94%) was observed in those of them with confirmed recanalization (51.5%). In contrast, half of the patients with pc-ASPECTS ≥ 8 and successful recanalization (73.2%) achieved good outcome. In these patients, OTT was associated with poor outcome neither as a continuous nor as a categorical variable. Factors independently associated with poor outcome were greater age and baseline National Institutes of Health Stroke Scale, lack of recanalization, history of atrial fibrillation, and sICH. In the model including the whole cohort (patients with any pc-ASPECTS), pc-ASPECTS < 8 was independently associated with poor outcome (odds ratio = 5.83, 95% confidence interval = 1.09-31.07).
In the absence of extensive baseline ischemia, recanalization of BAO up to 48 hours was seldom futile and produced good outcomes in 50% of patients, which was independent of time to treatment.
评估广泛基线缺血变化对基底动脉闭塞（BAO）溶栓后功能结局的影响，并研究在无此类发现的情况下治疗时间的影响。
我们前瞻性评估了 184 例经血管造影证实的 BAO 连续患者。大多数患者接受了静脉内阿替普酶和全剂量肝素治疗。广泛的基线缺血定义为后循环急性卒中预后早期 CT 评分（pc-ASPECTS）<8。发病至治疗时间（OTT）既作为连续变量又作为分类变量进行评估（0-6 小时、6-12 小时、12-24 小时和 24-48 小时）。成功再通表示血栓溶解治疗心肌梗死（TIMI）=2-3。症状性颅内出血（sICH）根据国立神经病学与卒中研究院、欧洲合作急性卒中研究 II 和卒中溶栓安全性评估标准进行评估。3 个月预后不良定义为改良 Rankin 量表评分 3-6。
基线 pc-ASPECTS<8 的患者中，大多数（96%）预后不良，且在确认再通的患者中（51.5%）也观察到类似比例（94%）。相比之下，基线 pc-ASPECTS≥8 且再通成功的患者中有一半（73.2%）预后良好。在这些患者中，OTT 既不是连续变量，也不是分类变量与不良结局相关。与不良结局独立相关的因素是年龄较大、基线国立卫生研究院卒中量表评分较高、无再通、心房颤动病史和 sICH。在包括所有患者（任何 pc-ASPECTS 的患者）的模型中，pc-ASPECTS<8 与不良结局独立相关（优势比=5.83，95%置信区间=1.09-31.07）。
在无广泛基线缺血的情况下，BAO 再通至 48 小时很少无效，50%的患者获得良好结局，与治疗时间无关。
