Werner Mariano, Lopez-Rueda Antonio, Zarco Federico, Román Luis San, Blasco Jordi, Amaro Sergio, Carrero Enrique, Fontanals Jaume, Oleaga Laura, Macho Juan, Bargallo Nuria
Hospital Clínic, Department of Radiology, University of Barcelona, Spain.
Hospital Clínic, Department of Radiology, University of Barcelona, Spain
Interv Neuroradiol. 2016 Jun;22(3):310-7. doi: 10.1177/1591019916631145. Epub 2016 Feb 22.
The objective of this study was to add more evidence about the efficacy and safety of mechanical thrombectomy in patients with basilar artery occlusion and secondarily to identify prognostic factors.
Twenty-two consecutive patients (mean age 60.5 years, 15 men) with basilar artery occlusion treated with mechanical thrombectomy were included. Clinical, procedure and radiological data were collected. Primary outcomes were the modified Rankin scale score with a good outcome defined by a modified Rankin scale score of 0-2 and mortality rate at three months.
The median National Institutes of Health stroke scale at admission was 24 (interquartile range 11.5-31.25). Twelve patients (54.5%) required tracheal intubation due to a decreased level of consciousness. Successful recanalisation (modified treatment in cerebral ischaemia scale 2b-3) was achieved in 20 patients (90.9%). A favourable clinical outcome (modified Rankin scale score 0-2) was observed in nine patients (40.9%) and the overall mortality rate was 40.9% (nine patients). Haemorrhagic events were observed in three patients (13.63%). A decreased level of consciousness requiring intubation in the acute setting was more frequent in patients with poor outcomes (84.6%) than in patients with favourable outcomes (11.1%), and in patients who died (100%) compared with those who survived (23.1%), with a statistically significant difference (P = 0.002 and P = 0.001, respectively).
Mechanical thrombectomy is feasible and effective in patients with acute basilar artery occlusion. A decreased level of consciousness requiring tracheal intubation seems to be a prognostic factor and is associated with a poor clinical outcome and higher mortality rate. These initial results must be confirmed by further prospective studies with a larger number of patients.
本研究的目的是补充更多关于基底动脉闭塞患者机械取栓术有效性和安全性的证据，并其次确定预后因素。
纳入22例连续接受机械取栓术治疗的基底动脉闭塞患者（平均年龄60.5岁，15例男性）。收集临床、手术和影像学数据。主要结局为改良Rankin量表评分，良好结局定义为改良Rankin量表评分为0 - 2分，以及3个月时的死亡率。
入院时美国国立卫生研究院卒中量表中位数为24（四分位间距11.5 - 31.25）。12例患者（54.5%）因意识水平下降需要气管插管。20例患者（90.9%）实现了成功再通（脑缺血改良治疗量表2b - 3级）。9例患者（40.9%）观察到良好的临床结局（改良Rankin量表评分0 - 2分），总体死亡率为40.9%（9例患者）。3例患者（13.63%）观察到出血事件。急性情况下需要插管的意识水平下降在预后不良的患者中（84.6%）比预后良好的患者中（11.1%）更常见，在死亡患者中（100%）比存活患者中（23.1%）更常见，差异有统计学意义（分别为P = 0.002和P = 0.001）。
机械取栓术在急性基底动脉闭塞患者中是可行且有效的。需要气管插管的意识水平下降似乎是一个预后因素，与不良临床结局和较高死亡率相关。这些初步结果必须通过更多患者的进一步前瞻性研究来证实。
