Department of Neurology, Goethe University, Frankfurt, Germany.
Ann Neurol. 2015 Mar;77(3):415-24. doi: 10.1002/ana.24336. Epub 2015 Jan 13.
A study was undertaken to evaluate clinical and procedural factors associated with outcome and recanalization in endovascular stroke treatment (EVT) of basilar artery (BA) occlusion.
ENDOSTROKE is an investigator-initiated multicenter registry for patients undergoing EVT. This analysis includes 148 consecutive patients with BA occlusion, with 59% having received intravenous thrombolysis prior to EVT. Recanalization (defined as Thrombolysis in Cerebral Infarction [TICI] score 2b-3) and collateral status (using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral grading system) were assessed by a blinded core laboratory. Good (moderate) outcome was defined as a modified Rankin Scale score of 0 to 2 (0-3) assessed after at least 3 months (median time to follow-up = 120 days).
Thirty-four percent had good and 42% had moderate clinical outcome; mortality was 35%. TICI 2b-3 recanalization was achieved by 79%. Age, hypertension, National Institutes of Health Stroke Scale scores, collateral status, and the use of magnetic resonance imaging prior to EVT predicted clinical outcome, the latter 3 remaining independent predictors in multivariate analysis. Independent predictors of recanalization were better collateral status and the use of a stent retriever. However, recanalization did not significantly predict clinical outcome.
Beside initial stroke severity, the collateral status predicts clinical outcome and recanalization in BA occlusion. Our data suggest that the use of a stent retriever is associated with high recanalization rates, but recanalization on its own does not predict outcome. The role of other modifiable factors, including the choice of pretreatment imaging modality and time issues, warrants further investigation.
本研究旨在评估血管内治疗（EVT）基底动脉（BA）闭塞患者结局和再通的临床及操作相关因素。
ENDOSTROKE 是一项针对接受 EVT 的患者的多中心前瞻性注册研究。本分析纳入了 148 例连续 BA 闭塞患者，其中 59%在 EVT 前接受了静脉溶栓治疗。再通（定义为血栓切除术溶栓评估[TICI]评分 2b-3）和侧支循环状态（采用美国介入治疗神经放射学会/介入放射学学会侧支分级系统）由盲法核心实验室评估。良好（中度）结局定义为至少 3 个月（中位随访时间为 120 天）后改良 Rankin 量表评分为 0-2（0-3）。
34%的患者有良好结局，42%的患者有中度结局；死亡率为 35%。TICI 2b-3 再通率为 79%。年龄、高血压、国立卫生研究院卒中量表评分、侧支循环状态和 EVT 前磁共振成像的使用预测临床结局，后 3 项是多变量分析中的独立预测因素。再通的独立预测因素是更好的侧支循环状态和使用支架取栓。然而，再通并不能显著预测临床结局。
除了初始卒中严重程度，侧支循环状态预测 BA 闭塞患者的临床结局和再通。我们的数据表明，支架取栓的使用与较高的再通率相关，但再通本身并不能预测结局。其他可改变因素（包括治疗前影像学检查方式的选择和时间问题）的作用值得进一步研究。
