巴西急性基底动脉闭塞患者的临床结局：一项观察性研究。
Clinical Outcomes of Patients with Acute Basilar Artery Occlusion in Brazil: An Observational Study.
作者信息
Dias Francisco Antunes, Alessio-Alves Frederico Fernandes, Castro-Afonso Luis Henrique, Cougo Pedro Telles, Barreira Clara Monteiro Antunes, Camilo Millene Rodrigues, Nakiri Guilherme Seizem, Abud Daniel Giansante, Pontes-Neto Octavio Marques
机构信息
Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas-Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
出版信息
J Stroke Cerebrovasc Dis. 2017 Oct;26(10):2191-2198. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.043. Epub 2017 May 24.
BACKGROUND
Intravenous thrombolysis (IVT) and endovascular therapy (EVT) were proven safe and effective for anterior circulation proximal occlusions. However, the most appropriate recanalization strategy in patients with acute basilar artery occlusion (BAO) is still controversial. This study aimed to assess outcomes of patients with BAO at an academic stroke center in Brazil.
METHODS
This is a retrospective analysis of consecutive patients with BAO from a prospective stroke registry at Ribeirão Preto Medical School. Primary outcomes were mortality and favorable outcome (modified Rankin score [mRS] ≤3) at 90 days. After univariate analyses, multivariate logistic regressions were used to identify independent predictors of primary outcomes.
RESULTS
Between August 2004 and December 2015, 63 (65% male) patients with BAO and median National Institutes of Health Stroke Scale (NIHSS) score of 31 (interquartile range: 19-36) were identified. Twenty-nine (46%) patients received no acute recanalization therapy, 15 (24%) received IVT, and 19 (30%) received EVT (68% treated with stent retrievers). Twenty-four (83%) patients treated conservatively died, and only 2 (7%) achieved an mRS less than or equal to 3. Among patients treated with acute recanalization therapies, 15 (44%) died, and 9 (26.5%) had a favorable outcome. On multivariate analysis, baseline systolic blood pressure (odds ratio [OR] = .97; 95% confidence interval [CI]: .95-0.99; P = .023), posterior circulation Alberta Stroke Program Early CT score (OR = .62; 95% CI: .41-0.94; P = .026), and successful recanalization (OR = .18; 95% CI: .04-0.71; P = .015) were independent predictors of lower mortality. Baseline NIHSS (OR = 1.40; 95% CI: 1.08-1.82; P = .012), prior use of statins (OR = .003; 95% CI: .001-0.28; P = .012), and successful recanalization (OR = .05; 95% CI: .001-0.27; P = .009) were independent predictors of favorable outcome. There was no significant difference between the IVT group and the EVT group on primary outcomes.
CONCLUSIONS
BAO is associated with high morbidity and mortality in Brazil. Access to acute recanalization therapies may decrease mortality in those patients.
背景
静脉溶栓（IVT）和血管内治疗（EVT）已被证明对前循环近端闭塞是安全有效的。然而，急性基底动脉闭塞（BAO）患者最合适的再通策略仍存在争议。本研究旨在评估巴西一家学术性卒中中心BAO患者的预后。
方法
这是一项对里贝朗普雷图医学院前瞻性卒中登记处连续的BAO患者进行的回顾性分析。主要结局是90天时的死亡率和良好结局（改良Rankin量表[mRS]≤3）。在单因素分析之后，使用多因素逻辑回归来确定主要结局的独立预测因素。
结果
在2004年8月至2015年12月期间，确定了63例（65%为男性）BAO患者，美国国立卫生研究院卒中量表（NIHSS）中位数评分为31（四分位间距：19 - 36）。29例（46%）患者未接受急性再通治疗，15例（24%）接受IVT，19例（30%）接受EVT（68%使用支架取栓器治疗）。24例（83%）接受保守治疗的患者死亡，只有2例（7%）mRS≤3。在接受急性再通治疗的患者中，15例（44%）死亡，9例（26.5%）有良好结局。多因素分析显示，基线收缩压（比值比[OR]=0.97；95%置信区间[CI]：0.95 - 0.99；P = 0.023）、后循环阿尔伯塔卒中项目早期CT评分（OR = 0.62；95% CI：0.41 - 0.94；P = 0.026）和成功再通（OR = 0.18；95% CI：0.04 - 0.71；P = 0.015）是较低死亡率的独立预测因素。基线NIHSS（OR = 1.40；95% CI：1.08 - 1.82；P = 0.012）、既往使用他汀类药物（OR = 0.003；95% CI：0.001 - 0.28；P = 0.012）和成功再通（OR = 0.05；95% CI：0.001 - 0.27；P = 0.009）是良好结局的独立预测因素。IVT组和EVT组在主要结局方面无显著差异。
结论
在巴西，BAO与高发病率和高死亡率相关。获得急性再通治疗可能会降低这些患者的死亡率。
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