Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Road Jianshe No. 1, Zhengzhou City, 450052, China.
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Neuroradiology. 2019 Dec;61(12):1477-1484. doi: 10.1007/s00234-019-02282-1. Epub 2019 Sep 4.
This study aimed to evaluate prognostic parameters associated with favorable clinical prognosis and assess the feasibility and safety of three different treatment strategies in patients with acute intracranial vertebrobasilar artery occlusion (VBAO).
A total of 159 patients with acute VBAO at 3 stroke centers between September 2015 and October 2018 were retrospectively analyzed. Eighty-nine patients underwent mechanical thrombectomy (MT) alone, 43 underwent MT with additional rescue angioplasty, and 27 underwent primary balloon angioplasty (without or with stenting). In patients treated with primary or rescue balloon angioplasty (without or with stenting), a low-dose intra-arterial tirofiban injection was used. The reperfusion status was assessed after the procedure, and the functional outcome was assessed at 90-day follow-up. The baseline characteristics and 90-day prognosis of three different treatment subgroups were comparatively analyzed.
Overall, successful reperfusion and a favorable outcome were achieved in 96.86% (154/159) and 46.54% (74/159) patients, respectively. The onset to puncture time (461.96 min vs 603.59 min, P = 0.000), procedure time (64.12 min vs 70.47 min, P = 0.007), and onset to reperfusion time (526.08 min vs 674.47 min, P = 0.000) were significantly shorter in patients with favorable outcomes than in those with poor outcomes. Among different endovascular treatment subgroups, no significant differences were found in successful reperfusion and 90-day outcome. Low-dose tirofiban did not increase the risk of symptomatic intracranial hemorrhage and the 90-day mortality in patients with acute VBAO.
Individualized endovascular treatment strategy for selected patients with acute VBAO could achieve satisfactory reperfusion rate and favorable prognosis.
本研究旨在评估与良好临床预后相关的预后参数，并评估三种不同治疗策略在急性颅内椎基底动脉闭塞（VBAO）患者中的可行性和安全性。
回顾性分析了 2015 年 9 月至 2018 年 10 月 3 家卒中中心的 159 例急性 VBAO 患者。89 例行单纯机械血栓切除术（MT），43 例行 MT 加额外的血管成形术，27 例行单纯球囊血管成形术（无支架或带支架）。对行单纯或补救性球囊血管成形术（无支架或带支架）的患者，采用小剂量动脉内替罗非班注射。术后评估再灌注情况，90 天随访评估功能结局。比较三组不同治疗亚组的基线特征和 90 天预后。
总体而言，159 例患者中，96.86%（154 例）实现了成功再灌注，46.54%（74 例）获得了良好的预后。预后良好组的发病至穿刺时间（461.96 分钟比 603.59 分钟，P=0.000）、手术时间（64.12 分钟比 70.47 分钟，P=0.007）和发病至再灌注时间（526.08 分钟比 674.47 分钟，P=0.000）明显短于预后不良组。在不同的血管内治疗亚组中，成功再灌注和 90 天预后无显著差异。急性 VBAO 患者使用小剂量替罗非班不会增加症状性颅内出血的风险和 90 天死亡率。
针对急性 VBAO 患者的个体化血管内治疗策略可获得满意的再灌注率和良好的预后。
