Pallesen Lars P, Khomenko Andrei, Dzialowski Imanuel, Barlinn Jessica, Barlinn Kristian, Zerna Charlotte, van der Hoeven Erik Jrj, Algra Ale, Kapelle L Jaap, Michel Patrik, Bodechtel Ulf, Demchuk Andrew M, Schonewille Wouter, Puetz Volker
1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
2 Department of Neurology, University of Regensburg, Regensburg, Germany.
Int J Stroke. 2017 Feb;12(2):145-151. doi: 10.1177/1747493016669886. Epub 2016 Oct 3.
Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. <8) and Pons-Midbrain Index (<3 vs. ≥3) with mortality and favourable outcome (modified Rankin Scale score 0-3) at one month. Results Of 619 patients in the Basilar Artery International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.
基底动脉闭塞患者出现昏迷与预后不良相关。
我们试图评估应用于CT血管造影源图像的后循环急性卒中预后早期CT评分和脑桥-中脑指数是否能预测基底动脉国际合作研究中昏迷患者的预后。
基底动脉国际合作研究是一项前瞻性观察性登记研究，纳入全球48个招募中心的急性基底动脉闭塞患者。我们将后循环急性卒中预后早期CT评分和脑桥-中脑指数应用于基底动脉国际合作研究中出现昏迷的患者的CT血管造影源图像。我们计算调整后的风险比，以评估二分法后循环急性卒中预后早期CT评分（≥8 vs. <8）和脑桥-中脑指数（<3 vs. ≥3）与1个月时死亡率和良好预后（改良Rankin量表评分0-3）之间的关联。
在基底动脉国际合作研究登记的619例患者中，158例患者有CT血管造影源图像可供审查。其中，78例患者（49%）出现昏迷。与非昏迷患者相比，昏迷患者死亡的可能性更大（风险比2.34；95%CI 1.56-3.52），获得良好预后的可能性更小（风险比0.44；95%CI 0.24-0.80）。在昏迷患者中，脑桥-中脑指数<3与死亡率降低相关（调整后RR 0.66；95%CI 0.46-0.96），但与良好预后无关（调整后RR 1.19；95%CI 0.39-3.62）。后循环急性卒中预后早期CT评分二分法为≥8 vs. <8与死亡无显著关联（调整后RR 0.70；95%CI 0.46-1.05）。
在基底动脉闭塞的昏迷患者中，脑干缺血的程度似乎与死亡率相关，但与良好预后无关。
