Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital Barcelona, Spain.
Eur J Radiol. 2019 Jul;116:219-224. doi: 10.1016/j.ejrad.2019.05.001. Epub 2019 May 2.
Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it.
To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke.
We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0-3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors.
Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8-30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52-25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09-38.24, p = 0.04) were independently associated with a good outcome.
Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.
血管内治疗被认为是急性后循环卒中患者的合理治疗方法，但仍不确定哪些患者将从中受益最大。
寻找血管内治疗后后循环卒中患者结局的独立临床和血管造影预测因素。
我们评估了 2015 年 1 月至 2017 年 12 月在我们的综合卒中中心接受血管内治疗的连续急性后循环卒中患者。90 天的改良 Rankin 评分为 0-3 定义为良好结局。在血管内治疗过程中记录的局灶性狭窄确定颅内动脉粥样硬化疾病。寻找良好结局与临床和血管造影因素之间的关联。使用调整后的逻辑回归模型来确定独立的结局预测因素。
共纳入 47 例连续患者：平均年龄 70.9±12.1 岁，中位入院 NIHSS 评分 16（IQR：8-30）。单因素分析显示，年龄（p=0.01）、吸烟（p=0.04）、高血压（p=0.03）、再通成功（p=0.04）、颅外动脉粥样硬化（p=0.02）和无动脉粥样硬化（p=0.03）与良好结局显著相关。多因素分析显示，年龄<70 岁（优势比=6.20，95%CI 1.52-25.47，p=0.01）和无颅内动脉粥样硬化（优势比=6.45，95%CI 1.09-38.24，p=0.04）与良好结局独立相关。
血管内治疗前确定颅内动脉粥样硬化的存在或不存在可以辅助后循环卒中患者的管理。颅内动脉粥样硬化的缺失可能作为未来试验中血管内治疗的阳性选择标准具有价值。颅内动脉粥样硬化的存在可以作为未来研究该人群新治疗方案的选择工具。
