Institute of Neuroradiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Dept. of Neurology, Charité-University Medicine Berlin, Berlin, Germany.
Clin Neuroradiol. 2019 Sep;29(3):435-443. doi: 10.1007/s00062-018-0683-3. Epub 2018 Apr 12.
To describe the clinical and radiological characteristics, frequency, technical aspects and outcome of endovascular treatment of acute basilar artery occlusion (ABO) in the setting of vertebrobasilar steno-occlusive disease.
Retrospective analysis of databases of two universitary stroke centers including all consecutive patients from January 2013 until May 2017 undergoing thrombectomy for a) acute stroke due to basilar artery occlusion and either significant basilar artery stenosis or vertebral artery stenosis/occlusion as well as b) presumed embolic basilar artery occlusions. Demographics, stroke characteristics, time metrics, recanalization results and outcome were recorded. Interventional strategies were evaluated concerning the thrombectomy technique, additional angioplasty, type of approach with respect to lesion pattern (ipsilateral to steno-occlusive VA lesion: dirty road or contralateral: clean road) and sequence of actions.
Out of 157 patients treated for ABO 38 (24.2%) had associated significant vertebrobasilar steno-occlusive lesions. An underlying significant basilar artery stenosis was present in 23.7% and additionally significant steno-occlusive vertebral lesions were present in 81.5%. Thrombectomy was performed with primary aspiration in 15.8% and with stent-retrievers in 84.2%. Successful revascularization (TICI 2b-3) was achieved in 86.8%. In 52.6% additional stent angioplasty was performed, in 7.9% balloon angioplasty only. The clean road approach was used in 22.5% of cases, the dirty road in 77.4%. Final modified Rankin scale (mRS) was 0-2 in 6 patients (15.8%) and 3-5 in 32 (84.2%). The in-hospital mortality was 36.8%. There were no statistically significant differences in outcome compared to presumed cases of embolisms.
Endovascular treatment of ABO with underlying significant vertebrobasilar steno-occlusive lesions is effective and reasonably safe. Specific procedural strategies apply depending on individual patient pathology and anatomy. Although high rates of recanalization can be achieved, outcomes tend to be poor.
描述急性基底动脉闭塞（ABO）在椎基底动脉狭窄闭塞性疾病中的临床和影像学特征、频率、技术方面及转归。
回顾性分析两所大学附属医院的数据库，包括 2013 年 1 月至 2017 年 5 月期间因 a）基底动脉闭塞引起的急性脑卒中且基底动脉狭窄或椎动脉狭窄/闭塞明显，以及 b）推测为基底动脉栓塞闭塞而接受血栓切除术的所有连续患者。记录人口统计学、脑卒中特征、时间指标、再通结果和转归。评估介入策略是否与血栓切除术技术、附加血管成形术、基于病变模式的入路类型（同侧椎动脉狭窄病变：脏路或对侧：净路）和操作顺序有关。
在 157 例 ABO 患者中，38 例（24.2%）伴有明显的椎基底动脉狭窄闭塞性病变。23.7%的患者存在基底动脉狭窄，81.5%的患者存在显著的狭窄闭塞性椎动脉病变。15.8%的患者采用直接抽吸血栓切除术，84.2%的患者采用支架取栓术。86.8%的患者达到成功再通（TICI 2b-3）。52.6%的患者行附加支架血管成形术，7.9%的患者行单纯球囊血管成形术。22.5%的患者采用净路入路，77.4%的患者采用脏路入路。6 例（15.8%）患者最终改良 Rankin 量表（mRS）评分为 0-2，32 例（84.2%）患者评分为 3-5。住院期间死亡率为 36.8%。与栓塞性病变患者相比，其转归无统计学差异。
伴有明显椎基底动脉狭窄闭塞性病变的 ABO 患者，血管内治疗有效且相对安全。具体的手术策略取决于患者的个体病理和解剖结构。虽然可以实现较高的再通率，但转归往往较差。
