Zhong Xi, Tong Xu, Sun Xuan, Gao Feng, Mo Dapeng, Wang Yilong, Miao Zhongrong
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Peking University Shougang Hospital, Beijing, China.
Front Neurol. 2020 Nov 19;11:592003. doi: 10.3389/fneur.2020.592003. eCollection 2020.
We aim to identify the risk factors of early neurological deterioration (END) despite successful recanalization and explore the association of END with 90-day outcomes in acute basilar artery occlusion (BAO) treated by endovascular therapy (EVT). A prospectively registered consecutive cohort of BAO patients with successful recanalization by EVT in a tertiary stroke center during a 6-year period was reviewed. END was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase ≥4 points, or death, from baseline to 24 h after EVT. Multivariate logistic regression analysis was used to identify the risk factors of END. The 90-day outcomes between END and non-END groups were compared by Pearson's χ test. END was observed in 21 of 148 patients included in this study. Multivariate logistic regression analysis showed that patients with progressive or fluctuating symptoms had a higher risk of END than those with symptoms of acute attack (OR 5.52, 95% CI 1.73-17.63), and NIHSS score and puncture-to-recanalization time (PTR), as continuous variables, were also significantly associated with END. Using a generalized additive model with spline smoothing function, we observed a linear relationship between PTR (increased by 1 h) and END (OR 2.57, 95% CI 1.45-4.57), and a non-linear relationship between NIHSS score and END. Only when the NIHSS score was ≥23 points was it related to END (OR 0.7, 95% CI 0.6-0.9). In addition, patients with END had a lower proportion of 90-day favorable outcome (19.0 vs. 59.1%, < 0.01) and higher mortality (33.3 vs. 13.4%, = 0.048) than those with non-END. Mode of stroke onset, NIHSS score, and PTR may help to identify BAO patients with a higher risk of END after EVT. Moreover, END may affect the 90-day outcomes of these patients.
我们旨在确定尽管再通成功但仍发生早期神经功能恶化（END）的危险因素，并探讨END与血管内治疗（EVT）治疗的急性基底动脉闭塞（BAO）患者90天预后的相关性。回顾了一个前瞻性注册的连续队列，该队列中的BAO患者在6年期间于一家三级卒中中心通过EVT成功实现再通。END定义为从基线到EVT后24小时，美国国立卫生研究院卒中量表（NIHSS）评分增加≥4分或死亡。采用多因素逻辑回归分析来确定END的危险因素。通过Pearson卡方检验比较END组和非END组的90天预后。本研究纳入的148例患者中有21例出现END。多因素逻辑回归分析显示，症状呈进行性或波动性的患者发生END的风险高于急性发作症状的患者（OR 5.52，95%CI 1.73-17.63），并且作为连续变量的NIHSS评分和穿刺至再通时间（PTR）也与END显著相关。使用具有样条平滑函数的广义相加模型，我们观察到PTR（每增加1小时）与END之间存在线性关系（OR 2.57，95%CI 1.45-4.57），以及NIHSS评分与END之间存在非线性关系。仅当NIHSS评分≥23分时才与END相关（OR 0.7，95%CI 0.6-0.9）。此外，与非END患者相比，END患者90天良好预后的比例更低（19.0%对59.1%，P<0.01），死亡率更高（33.3%对13.4%，P = 0.048）。卒中发作方式、NIHSS评分和PTR可能有助于识别EVT后发生END风险较高的BAO患者。此外，END可能会影响这些患者的90天预后。
