Yoshimoto Takeshi, Tanaka Kanta, Yamagami Hiroshi, Uchida Kazutaka, Inoue Manabu, Koge Junpei, Ihara Masafumi, Toyoda Kazunori, Imamura Hirotoshi, Ohara Nobuyuki, Morimoto Takeshi, Sakai Nobuyuki, Yoshimura Shinichi
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105256. doi: 10.1016/j.jstrokecerebrovasdis.2020.105256. Epub 2020 Sep 4.
We hypothesized that the relationships between treatments and outcomes in acute basilar artery occlusion (BAO) are different, depending on the severity of initial neurological deficits.
Of 2420 ischemic stroke patients with large vessel occlusion in a prospective, multicenter registry in Japan, patients with acute BAO were enrolled. Subjects were divided into two severity groups according to the baseline NIH Stroke Scale score: severe (≥10) and mild (<10) groups. The primary effectiveness outcome was favorable outcome, defined as modified Rankin Scale score 0-3 at 3 months. Safety outcomes included any intracranial hemorrhage (ICH) within 72 h. Outcomes in each group were compared between patients who received endovascular therapy (EVT) and those with standard medical treatment (SMT).
In this study, 167 patients (52 female; median age 75 years) were analyzed. The favorable outcome was seen in 93 patients (56%) overall. In the severe group (n = 128), the proportion of favorable outcome was higher in patients who received EVT (60/111, 54%) than those with SMT (2/17, 12%, P < 0.01). In the mild group (n = 39), the rates of favorable outcome were comparable between the EVT (13/18, 72%) and SMT patients (18/21, 86%, P = 0.43). No significant differences in the rates of any ICH were seen among any groups.
In acute BAO stroke with severe neurological deficit, independent ambulation was more frequently seen in patients who received EVT than those with SMT. Patients with mild neurological deficits showed similar rates of independent ambulation between the two treatment selections.
我们推测，急性基底动脉闭塞（BAO）的治疗与预后之间的关系因初始神经功能缺损的严重程度而异。
在日本一项前瞻性多中心登记研究中，纳入了2420例患有大血管闭塞的缺血性卒中患者，其中包括急性BAO患者。根据基线美国国立卫生研究院卒中量表（NIH Stroke Scale）评分，将受试者分为两个严重程度组：重度（≥10分）组和轻度（<10分）组。主要有效性结局为良好预后，定义为3个月时改良Rankin量表评分为0 - 3分。安全性结局包括72小时内发生的任何颅内出血（ICH）。比较接受血管内治疗（EVT）的患者和接受标准药物治疗（SMT）的患者在每组中的结局。
本研究共分析了167例患者（52例女性；中位年龄75岁）。总体上有93例患者（56%）获得了良好预后。在重度组（n = 128）中，接受EVT的患者良好预后的比例（60/111，54%）高于接受SMT的患者（2/17，12%，P < 0.01）。在轻度组（n = 39）中，EVT患者（13/18，72%）和SMT患者（18/21，86%）的良好预后率相当（P = 0.43）。各组间任何ICH发生率均无显著差异。
在急性BAO卒中且神经功能缺损严重的患者中，接受EVT的患者比接受SMT的患者更常出现独立行走。神经功能缺损轻度的患者在两种治疗选择下的独立行走率相似。
