直接血管成形术治疗动脉粥样硬化所致急性基底动脉闭塞的安全性和有效性
Safety and Efficacy of Direct Angioplasty in Acute Basilar Artery Occlusion Due to Atherosclerosis.
作者信息
Ma Gaoting, Sun Xuan, Tong Xu, Jia Baixue, Huo Xiaochuan, Luo Gang, Wang Bo, Deng Yiming, Gao Feng, Song Ligang, Ma Ning, Miao Zhongrong, Mo Dapeng
机构信息
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
出版信息
Front Neurol. 2021 Jul 19;12:651653. doi: 10.3389/fneur.2021.651653. eCollection 2021.
Endovascular treatment (EVT) is one of the promising treatment options in patients with intracranial atherosclerotic disease (ICAD)-related basilar artery occlusion (BAO). In this study, we compared the safety and efficacy of direct angioplasty (DA) with stent-retriever thrombectomy (SRT) with or without rescue treatment in ICAD-related BAO. We retrospectively evaluated 187 patients who underwent EVT for BAO from January 2012 to July 2018. We identified patients who underwent EVT due to ICAD-related BAO. Patients who accepted SRT with or without rescue treatment were classified into the SRT group. Patients treated with DA with or without stent placement were classified into DA group. Clinical and laboratory findings and outcomes were compared between groups. A total of 108 patients were enrolled, among them 77 underwent SRT and 31 underwent DA; 61 (79.2%) SRT group patients underwent angioplasty with or without stent placement. Compared with patients in the SRT group, those in the DA group experienced a significantly shorter procedure time [60 min (60-120 min) vs. 120 min (60-120 min); = 0.038] and a lower number of device passes [2 passes (1-2 passes) vs. 3 passes (2-4 passes); < 0.001]. No significant differences in balloon angioplasty (35.5 vs. 22.1%; = 0.150), emergent stent placement (64.5 vs. 57.1%; = 0.481), successful recanalization (93.5 vs. 85.7%; = 0.340), embolization in distal or new territory (3.2 vs. 9.1%, = 0.314), and reocclusion (22.6 vs. 9.1%; = 0.109) among DA and SRT groups were found. Additionally, no differences in symptomatic intracranial hemorrhage incidence [adjusted odds ratio (OR), 0.74; 95% CI, 0.06-9.44; = 0.815], functional independence (adjusted OR, 1.44; 95% CI, 0.50-4.16; = 0.497), and mortality rate (adjusted OR, 0.36; 95% CI, 0.06-2.04; = 0.247) were noted among groups. In certain patients with ICAD-related BAO, DA may shorten procedure time and reduce required device passes compared to SRT. In this study, DA was retrospectively found to be of similar safety and efficacy as SRT.
血管内治疗（EVT）是颅内动脉粥样硬化疾病（ICAD）相关基底动脉闭塞（BAO）患者有前景的治疗选择之一。在本研究中，我们比较了直接血管成形术（DA）与支架取栓术（SRT）在ICAD相关BAO患者中进行或不进行补救治疗时的安全性和有效性。我们回顾性评估了2012年1月至2018年7月因BAO接受EVT的187例患者。我们确定了因ICAD相关BAO接受EVT的患者。接受SRT进行或不进行补救治疗的患者被分类到SRT组。接受DA进行或不进行支架置入的患者被分类到DA组。比较两组之间的临床、实验室检查结果和结局。共纳入108例患者，其中77例接受SRT，31例接受DA；SRT组61例（79.2%）患者进行了血管成形术并进行或未进行支架置入。与SRT组患者相比，DA组患者的手术时间显著更短[60分钟（60 - 120分钟）对120分钟（60 - 120分钟）；P = 0.038]，器械通过次数更少[2次（1 - 2次）对3次（2 - 4次）；P < 0.001]。DA组和SRT组在球囊血管成形术（35.5%对22.1%；P = 0.150）、急诊支架置入（64.5%对57.1%；P = 0.481）、成功再通（93.5%对85.7%；P = 0.340）、远端或新区域栓塞（3.2%对9.1%，P = 0.314）以及再闭塞（22.6%对9.1%；P = 0.109）方面未发现显著差异。此外，在症状性颅内出血发生率[调整后的优势比（OR），0.74；95%置信区间（CI），0.06 - 9.44；P = 0.
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