Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France.
Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Clin Neuroradiol. 2021 Dec;31(4):1131-1140. doi: 10.1007/s00062-021-01001-9. Epub 2021 Mar 11.
Acute ischemic stroke (AIS) secondary to a basilar artery occlusion (BAO) carries a poor prognosis, especially in cases of severe symptoms, such as coma at presentation. Despite a lack of evidence, mechanical thrombectomy (MT) is often performed as the procedural risks are felt to be minimal compared to the natural history. We sought to evaluate MT efficacy and safety in comatose BAO patients.
We performed a retrospective analysis of a multicenter prospective cohort of consecutive AIS patients with BAO who underwent MT. We compared baseline characteristics between comatose and noncomatose BAO patients, as well as clinical outcomes (modified Rankin scale, mRS 0-3 at 3 months). Using a multivariate logistic regression, we examined the population of comatose patients for baseline predictive factors of mortality.
We included 269 patients, 72 (27%) comatose and 197 (73%) non-comatose. Despite similar recanalization rates between comatose and non-comatose patients (83% vs. 90% p = 0.221), comatose patient long-term outcomes were dramatically worse (11% mRS 0-3 vs. 54%, p < 0.0001) and mortality was higher (64% vs. 34%, p < 0.0001). Baseline predictors of mortality at 3 months among comatose BAO patients after multivariate analysis were the following: male sex (odds ratio, OR 31.20, 2.57-378.52, p = 0.007), older age (OR 1.13, 1.04-1.24, p = 0.007) and higher serum glucose levels (OR 1.54, 1.07-2.21, p = 0.019).
Thrombectomy is technically effective for BAO patients presenting with coma; however, the long-term favorable outcome remains poor. Male sex, old age and hyperglycemia were predictors of mortality in these patients.
基底动脉闭塞（BAO）引起的急性缺血性脑卒中（AIS）预后较差，尤其是在出现昏迷等严重症状的情况下。尽管缺乏证据，但机械取栓（MT）经常被用于治疗，因为与自然病程相比，手术风险被认为很小。我们旨在评估昏迷的 BAO 患者行 MT 的疗效和安全性。
我们对接受 MT 的连续 AIS 伴 BAO 的多中心前瞻性队列进行了回顾性分析。我们比较了昏迷和非昏迷 BAO 患者的基线特征，以及临床结局（改良 Rankin 量表，3 个月时 0-3 分）。使用多变量逻辑回归，我们检查了昏迷患者的基线预测因素，以确定死亡率的人群因素。
我们纳入了 269 例患者，其中 72 例（27%）为昏迷，197 例（73%）为非昏迷。尽管昏迷和非昏迷患者的再通率相似（83%比 90%，p=0.221），但昏迷患者的长期结局明显更差（11%的 mRS 0-3 分比 54%，p<0.0001），死亡率更高（64%比 34%，p<0.0001）。多变量分析后，昏迷的 BAO 患者在 3 个月时死亡的基线预测因素包括：男性（优势比，OR 31.20，2.57-378.52，p=0.007）、年龄较大（OR 1.13，1.04-1.24，p=0.007）和血糖水平较高（OR 1.54，1.07-2.21，p=0.019）。
对于昏迷的 BAO 患者，血栓切除术在技术上是有效的，但长期预后仍然较差。男性、年龄较大和高血糖是这些患者死亡的预测因素。
