Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
World Neurosurg. 2021 Mar;147:e363-e372. doi: 10.1016/j.wneu.2020.12.060. Epub 2020 Dec 17.
Acute basilar artery occlusion is a devastating life-threatening condition. Early recanalization is the therapeutic goal in patients with acute ischemic stroke. Despite the high rates of recanalization achieved with modern devices for basilar occlusions, many patients have had poor clinical outcomes. This study aimed to assess the predictors of good and poor outcomes among patients with basilar artery occlusion treated with thrombectomy.
A consecutive registry of 80 patients was included in this retrospective study. The primary end point was to access variables associated with neurologic outcomes defined by a modified Rankin Scale (mRS) score of 0-2, symptomatic intracranial hemorrhage (sICH), and mortality at 3 months follow-up.
Recanalization was achieved in 86.2%, and the sICH rate was 8.7%. A good neurologic outcome (mRS score 0-2) was observed in 26.2% and a moderate outcome (mRS score 0-3) in 32.5% of patients. The mortality was 38.7% at 3 months follow-up.
After thrombectomy for posterior circulation strokes, young patients, V4-proximal basilar occlusion, (high) baseline posterior circulation Alberta Stroke Program Early CT Score, and complete recanalization were independent predictors of good neurologic outcomes. Failure to recanalize was strongly related to sICH and mortality. In addition, diabetes, atrial fibrillation, and baseline National Institutes of Health Stroke Scale scores ≥10 had an independent association with mortality. This study contributes to the knowledge required to optimize recanalization treatments for posterior circulation strokes and may help to improve future clinical studies.
急性基底动脉闭塞是一种具有破坏性的危及生命的疾病。在急性缺血性脑卒中患者中，早期再通是治疗目标。尽管现代基底动脉闭塞再通装置的再通率较高，但许多患者的临床预后仍较差。本研究旨在评估接受血栓切除术治疗的基底动脉闭塞患者的良好和不良结局的预测因素。
本回顾性研究连续纳入了 80 例患者。主要终点是评估与神经功能结局相关的变量，定义为改良 Rankin 量表（mRS）评分 0-2、症状性颅内出血（sICH）和 3 个月随访时的死亡率。
再通率为 86.2%，sICH 发生率为 8.7%。26.2%的患者神经功能良好（mRS 评分 0-2），32.5%的患者神经功能中度改善（mRS 评分 0-3）。3 个月随访时的死亡率为 38.7%。
在后循环卒中接受血栓切除术治疗后，年轻患者、V4 段近端基底动脉闭塞、（高）基线后循环 Alberta 卒中项目早期 CT 评分和完全再通是良好神经功能结局的独立预测因素。未能再通与 sICH 和死亡率密切相关。此外，糖尿病、心房颤动和基线 NIHSS 评分≥10 与死亡率有独立关联。本研究有助于优化后循环卒中再通治疗所需的知识，并可能有助于改进未来的临床研究。
