Giorgianni Andrea, Biraschi Francesco, Piano Mariangela, Mardighian Dikran, Gasparotti Roberto, Frigerio Michele, Pero Guglielmo, Quilici Luca, Crispino Mario, Pellegrino Carlo, Pavia Marco, Peroni Roberto, Longoni Marco, Cellerini Martino, Lafe Elvis, Remida Paolo, Faragò Giuseppe, Reganati Paolo, Strocchi Sabina, Valvassori Luca
Ospedale di Circolo e Fondazione Macchi-Varese.
Policlinico Umberto I Roma, Dipartimento Neuroscienze Umane Università Sapienza.
J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2367-2374. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.022. Epub 2018 Jun 27.
Acute basilar artery occlusion (BAO) is considered among the most severe medical emergencies, with very high morbidity and mortality. The aims of this study are to present 5 years experience of 12 centers in Lombardy region on BAO endovascular treatment and to evaluate prognostic factors that may improve clinical outcomes and recanalization rates.
Registro Endovascolare Lombardo Occlusione Basilar Artery (RELOBA) registry is a retrospective multicentric collection of patients with acute BAO who underwent endovascular treatment between 2010 and 2015. A total of 102 patients (mean age 65 years) were included. Clinical, procedural, and neuroradiological data were collected. Angiographic results (Treatment in Cerebral Ischemia scale [TICI] score 2b-3) were assessed by each center's interventional neuroradiologist. Good clinical outcome was considered as a modified Rankin Scale score ranging between 0 and 2 in a 3-month follow-up.
Thirty-nine percent of patients showed good clinical outcome at 3 months. Mortality rate was 30%. TICI 2b-3 was achieved in 62% of patients. Univariate analysis showed that age, National Institutes of Health Stroke Scale (NIHSS) at onset, time to recanalization, and TICI score were all statistically significant clinical outcome predictors (P < .05). Multivariate logistic regression showed that time to recanalization, age, and NIHSS at onset were significant independent predictors of good outcome.
BAO treatment needs more efforts to assure patients better clinical outcomes. Mechanical thrombectomy is feasible and effective in patients with acute BAO. These results must be confirmed by further prospective studies within randomized controlled settings.
急性基底动脉闭塞（BAO）被认为是最严重的医疗急症之一，发病率和死亡率极高。本研究的目的是介绍伦巴第地区12个中心在BAO血管内治疗方面的5年经验，并评估可能改善临床结局和再通率的预后因素。
伦巴第基底动脉闭塞血管内注册研究（RELOBA）是一项回顾性多中心研究，收集了2010年至2015年间接受血管内治疗的急性BAO患者。共纳入102例患者（平均年龄65岁）。收集临床、手术和神经放射学数据。各中心的介入神经放射科医生评估血管造影结果（脑缺血治疗量表[TICI]评分2b - 3）。良好的临床结局被定义为3个月随访时改良Rankin量表评分为0至2分。
39%的患者在3个月时显示出良好的临床结局。死亡率为30%。62%的患者实现了TICI 2b - 3级再通。单因素分析显示，年龄、发病时的美国国立卫生研究院卒中量表（NIHSS）评分、再通时间和TICI评分均为具有统计学意义的临床结局预测因素（P < 0.05）。多因素逻辑回归显示，再通时间、年龄和发病时的NIHSS评分是良好结局的显著独立预测因素。
BAO治疗需要做出更多努力以确保患者获得更好的临床结局。机械取栓术对急性BAO患者可行且有效。这些结果必须在随机对照环境下通过进一步的前瞻性研究加以证实。
