Department of Neurology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan.
Clin Neurol Neurosurg. 2020 Jul;194:105796. doi: 10.1016/j.clineuro.2020.105796. Epub 2020 Mar 19.
Mechanical thrombectomy (MT) following intravenous administration of recombinant tissue-type plasminogen activator (IV-rt-PA) is considered an effective treatment for the occlusion of the internal carotid artery or the M1 segment of the middle cerebral artery. However, its efficacy in treating basilar artery (BA) occlusion is still unclear. In order to evaluate the efficacy of MT in treating BA occlusion, we aimed to analyzed the clinical outcomes of those patients who had undergone MT following IV-rt-PA administration.
We retrospectively analyzed the clinical outcomes of 11 patients with BA occlusion who had undergone MT following IV-rt-PA administration between January 1, 2015, and March 31, 2019.
The patients consisted of 8 men and 3 women. The mean (±standard deviation) age was 73 ± 9.4 years. Stroke subtypes were found to be atherothrombosis in 2 patients, cardiogenic embolism in 6, arterial dissection in 1, and an unknown cause in 2. The median pretreatment scores were 9 on the Glasgow Coma Scale (GCS) and 25 on the National Institutes of Health Stroke Scale. The time elapsed from onset of the stroke to reperfusion was 281 min. Successful reperfusion, characterized by a modified Thrombolysis in Cerebral Infarction grade ≥ 2b, was achieved in all patients. The 3-month outcomes were good [modified Rankin Scale (mRS) 0-2] in 5 patients and poor (mRS 3-6) in 6 patients. The pretreatment median GCS scores were significantly higher in patients with a good outcome compared to that in those with a poor outcome with scores of 11 and 7.5, respectively (P = 0.044). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score on the GCS was 9.5 [area under the curve (AUC), 0.867; sensitivity, 0.8; specificity, 1.0]. Complications occurred in 1 patient with arterial dissection who had developed a subarachnoid hemorrhage and later died.
The results of the present study suggests that the pretreatment GCS score might affect the clinical outcomes in patients with BA occlusion who underwent MT following IV-rt-PA therapy.
静脉注射重组组织型纤溶酶原激活剂（IV-rt-PA）后进行机械血栓切除术（MT）被认为是治疗颈内动脉或大脑中动脉 M1 段闭塞的有效方法。然而，其在治疗基底动脉（BA）闭塞中的疗效尚不清楚。为了评估 MT 治疗 BA 闭塞的疗效，我们旨在分析接受 IV-rt-PA 治疗后行 MT 的患者的临床结局。
我们回顾性分析了 2015 年 1 月 1 日至 2019 年 3 月 31 日期间接受 IV-rt-PA 治疗后行 MT 的 11 例 BA 闭塞患者的临床结局。
患者中包括 8 名男性和 3 名女性。平均（±标准差）年龄为 73±9.4 岁。卒中亚型为 2 例动脉粥样硬化血栓形成，6 例心源性栓塞，1 例动脉夹层，2 例原因不明。治疗前的格拉斯哥昏迷量表（GCS）评分中位数为 9 分，国立卫生研究院卒中量表（NIHSS）评分为 25 分。从卒中发作到再灌注的时间为 281 分钟。所有患者均成功再通，改良血栓溶解脑梗死分级（mTICI）≥2b。3 个月时预后良好（mRS 0-2）5 例，预后不良（mRS 3-6）6 例。预后良好组治疗前的 GCS 评分中位数显著高于预后不良组，分别为 11 分和 7.5 分（P=0.044）。受试者工作特征（ROC）曲线分析显示，GCS 的最佳截断值为 9.5[曲线下面积（AUC）为 0.867；灵敏度为 0.8；特异性为 1.0]。1 例动脉夹层患者发生蛛网膜下腔出血，后死亡。
本研究结果表明，BA 闭塞患者接受 IV-rt-PA 治疗后行 MT，治疗前的 GCS 评分可能影响临床结局。
