Ritvonen Juhani, Sairanen Tiina, Silvennoinen Heli, Virtanen Pekka, Salonen Oili, Lindsberg Perttu J, Strbian Daniel
Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.
Front Neurol. 2021 May 4;12:665317. doi: 10.3389/fneur.2021.665317. eCollection 2021.
Around 30-60% of patients with basilar artery occlusion (BAO) present with coma, which is often considered as a hallmark of poor prognosis. To examine factors that will help predict outcomes in patients with BAO comatose on admission. A total of 312 patients with angiography-proven BAO were analyzed. Comas were assessed as Glasgow Coma Scale (GCS) of ≤8 or impaired level of consciousness ascertained in the medical records. Outcomes were evaluated with the modified Rankin Scale (mRS) over a phone call at 3 months. In our study, 53 patients were excluded due to inadequate data on the level of consciousness. In total, 103/259 (39.8%) of BAO patients were comatose on admission. Factors associated with acute coma were higher age, coronary artery disease, convulsions, extent of early ischemia by posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) < 8, absence of patent posterior collateral vasculature, and occlusion over multiple segments of BA. A total of 21/103 (20.4%) of comatose patients had a favorable outcome (mRS 0-3), and 12/103 (11.7%) had a good outcome (mRS 0-2). Factors associated with a favorable outcome in comatose BAO patients were younger age ( = 0.010), less extensive baseline ischemia ( = 0.027), recanalization ( = 0.013), and avoiding symptomatic intracranial hemorrhage (sICH) ( = 0.038). Factors associated with the poorest outcome or death (mRS 5-6) were older age ( = 0.001), diabetes ( = 0.022), atrial fibrillation ( = 0.016), lower median GCS [4 (IQR 3.6) vs. 6 (5-8); = 0.006], pc-ASPECTS < 8 ( = 0.003), unsuccessful recanalization ( = 0.006), and sICH ( = 0.010). Futile recanalization (mRS 4-6) was significantly more common in comatose patients (49.4 vs. 18.5%, < 0.001). One in five BAO patients with acute coma had a favorable outcome. Older patients with cardiovascular comorbidities and already existing ischemic lesions before reperfusion therapies tended to have a poor prognosis, especially if no recanalization is achieved and sICH occurred.
约30%-60%的基底动脉闭塞（BAO）患者会出现昏迷，这通常被视为预后不良的标志。为了研究有助于预测入院时昏迷的BAO患者预后的因素。共分析了312例经血管造影证实为BAO的患者。昏迷程度根据格拉斯哥昏迷量表（GCS）≤8或病历中确定的意识水平受损来评估。在3个月时通过电话随访，采用改良Rankin量表（mRS）评估预后。在我们的研究中，53例患者因意识水平数据不足而被排除。总共有103/259（39.8%）的BAO患者入院时昏迷。与急性昏迷相关的因素包括年龄较大、冠状动脉疾病、抽搐、后循环急性卒中预后早期CT评分（pc-ASPECTS）<8、后交通侧支血管未开放以及BA多节段闭塞。103例昏迷患者中共有21例（20.4%）预后良好（mRS 0-3），12例（11.7%）预后较好（mRS 0-2）。昏迷的BAO患者预后良好的相关因素包括年龄较小（P = 0.010）、基线缺血范围较小（P = 0.027）、再通（P = 0.013）以及避免发生有症状性颅内出血（sICH）（P = 0.038）。与最差预后或死亡（mRS 5-6）相关的因素包括年龄较大（P = 0.001）、糖尿病（P = 0.022）、心房颤动（P = 0.016）、较低的GCS中位数[4（四分位间距3.6）对6（5-8）；P = 0.006]、pc-ASPECTS<8（P = 0.003）、再通失败（P = 0.006）以及sICH（P = 0.010）。无效再通（mRS 4-6）在昏迷患者中显著更常见（49.4%对18.5%，P<0.001）。五分之一急性昏迷的BAO患者预后良好。患有心血管合并症且在再灌注治疗前已有缺血性病变的老年患者预后往往较差，尤其是在未实现再通且发生sICH的情况下。
