Wu Longfei, Rajah Gary B, Cosky Eric E, Wu Xiling, Li Chuanhui, Chen Jian, Zhao Wenbo, Wu Di, Ding Yuchuan, Ji Xunming
1Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
2Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Aging Dis. 2021 Apr 1;12(2):404-414. doi: 10.14336/AD.2020.0704. eCollection 2021 Apr.
Acute ischemic stroke due to basilar artery occlusion (BAO) carries a very poor prognosis. Functional outcomes in BAO patients undergoing endovascular therapy (EVT) may differ according to the specific pathological mechanisms. We aimed to explore the impact of the underlying pathological mechanisms on prognosis at 90-days and long-term follow-up in BAO patients treated with EVT. We analyzed consecutive BAO patients undergoing EVT from December 2012 to December 2018 at a single center (Xuanwu Hospital). Patients were classified into either an intracranial atherosclerotic disease (ICAD) group or an embolic group according to the corresponding angiographic findings. The baseline characteristics and functional outcomes were compared between the two groups. Multivariable logistic regression analysis was performed. Among the 167 patients enrolled, 78 patients (46.7%) were in the ICAD group and 89 patients (53.3%) were assigned to the embolic group. Overall, 149 patients (89.2%) achieved successful reperfusion post-EVT. There were no significant differences in functional outcomes at 90-days and long-term follow-up between the two groups. Similarly, a Kaplan-Meier survival analysis showed similar long-term survival probabilities (P = 0.438). The pathological mechanism was not associated with functional independence (OR, 1.818; 95% CI, 0.694-4.761; P = 0.224), favorable outcome (OR, 1.476; 95% CI, 0.592-3.681; P = 0.403), or mortality (OR, 1.249; 95% CI, 0.483-3.226; P = 0.646). However, based on subgroup analysis, embolic BAO versus ICAD was significantly associated with better functional independence in those aged 60 years and younger (OR, 4.513; 95% CI, 1.138-17.902). In this study, no differences in either 90-days or long-term functional outcomes between ICAD-related BAO and embolic BAO patients undergoing EVT were observed. However, in BAO patients aged ≤ 60 years, the pathological mechanism of embolism was associated with better functional independence.
基底动脉闭塞（BAO）所致急性缺血性卒中预后极差。接受血管内治疗（EVT）的BAO患者的功能结局可能因具体病理机制而异。我们旨在探讨潜在病理机制对接受EVT治疗的BAO患者90天及长期随访预后的影响。我们分析了2012年12月至2018年12月在单中心（宣武医院）接受EVT的连续BAO患者。根据相应血管造影结果将患者分为颅内动脉粥样硬化疾病（ICAD）组或栓塞组。比较两组的基线特征和功能结局。进行多变量逻辑回归分析。在纳入的167例患者中，78例（46.7%）在ICAD组，89例（53.3%）被分配到栓塞组。总体而言，149例（89.2%）患者在EVT后实现了成功再灌注。两组在90天及长期随访时的功能结局无显著差异。同样，Kaplan-Meier生存分析显示长期生存概率相似（P = 0.438）。病理机制与功能独立（比值比[OR]，1.818；95%置信区间[CI]，0.694 - 4.761；P = 0.224）、良好结局（OR，1.476；95% CI，0.592 - 3.681；P = 0.403）或死亡率（OR，1.249；95% CI，0.483 - 3.226；P = 0.646）无关。然而，基于亚组分析，在60岁及以下患者中，栓塞性BAO与ICAD相比，与更好的功能独立显著相关（OR，4.513；95% CI，1.138 - 17.902）。在本研究中，未观察到接受EVT的ICAD相关BAO和栓塞性BAO患者在90天或长期功能结局上的差异。然而，在年龄≤60岁的BAO患者中，栓塞病理机制与更好的功能独立相关。
