Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Eur J Neurol. 2021 Jan;28(1):117-123. doi: 10.1111/ene.14487. Epub 2020 Sep 17.
Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO.
We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI.
A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI.
Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.
机械取栓（MT）是前循环大血管闭塞患者的标准治疗方法。早期神经功能改善（ENI）定义为与基线评分相比，国立卫生研究院卒中量表（NIHSS）评分降低≥8 分，或 MT 后 24 小时 NIHSS 评分为 0 或 1 分，是此类患者 3 个月预后良好的有力预测指标。MT 后基底动脉闭塞（BAO）患者的 ENI 对 3 个月结局的影响尚不清楚。我们旨在研究 BAO 患者的 ENI 效果。
我们对所有接受 MT 的连续 BAO 卒中患者进行了多中心前瞻性队列的回顾性分析。我们根据 ENI 状态比较 BAO 患者组的临床结局。进行多变量分析以确定 ENI 对 90 天良好结局（改良 Rankin 量表评分 0-3）的影响，并报告促成 ENI 的因素。
共纳入 237 例患者。70 例（30%）患者出现 ENI。ENI 阳性患者的结局明显更好，3 个月时 84%达到良好结局（mRS 评分 0-3），而 ENI 阴性患者为 30%（P<0.0001）。多变量分析显示，ENI 是与较高良好结局率相关的独立预测因素{优势比（OR）18.12 [95%置信区间（CI）3.95-83.10]；P=0.0001}。更多的取栓次数[OR 0.62（95% CI 0.43-0.89）；P=0.010]和支架置入的需求[OR 0.27（95% CI 0.07-0.95）；P=0.041]与 ENI 呈负相关。
MT 后第 1 天的早期神经功能改善是 BAO 患者 3 个月临床结局良好的有力独立预测指标。
