Huang Jiacheng, Kong Weilin, Qiu Zhongming, Liu Da, Li Huagang, Zhou Peiyang, Yan Zhizhong, Wang Yan, Dai Weipeng, Zheng Chong, Li Rongzong, Wang Jian, Song Jiaxing, Yuan Junjie, Luo Weidong, Liu Shuai, Li Linyu, Sang Hongfei, Li Fengli, Wu Deping, Yang Qingwu, Zi Wenjie
1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (formerly the Third Military Medical University), Chongqing.
2Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, Yunnan.
J Neurosurg. 2022 Feb 18;137(4):1081-1087. doi: 10.3171/2021.12.JNS212543. Print 2022 Oct 1.
Authors of this study aimed to investigate the efficacy and safety of endovascular treatment (EVT) versus standard medical treatment (SMT) alone in patients with acute basilar artery occlusion (BAO) and moderate deficit (National Institutes of Health Stroke Scale [NIHSS] score 10-19).
Patients with moderate deficit caused by acute BAO in the period from January 2014 to May 2019 were included in the study. The patients were divided into groups based on treatment: EVT plus SMT group or SMT-alone group. The primary outcome was favorable functional outcome (modified Rankin Scale score 0-3) at 90 days, and safety outcomes were symptomatic intracerebral hemorrhage (sICH) and mortality at 90 days.
A total of 173 patients had moderate deficits, 128 of whom had been treated with EVT and 45 with SMT alone. EVT was associated with a significant higher proportion of 90-day favorable outcomes compared with SMT (adjusted odds ratio [aOR] 4.09, 95% CI 1.39-12.04, p = 0.011). Younger age (aOR 0.96, 95% CI 0.92-0.99, p = 0.017), absence of diabetes mellitus (aOR 0.35, 95% CI 0.12-0.99, p = 0.048), higher baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS; aOR 1.48, 95% CI 1.07-2.05, p = 0.018), and modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b-3 (aOR 15.15, 95% CI 3.07-74.72, p = 0.001) were independent factors for a favorable outcome in the EVT group. Rates of mortality and sICH were comparable in the EVT and SMT groups.
EVT leads to improved outcomes compared to those with SMT alone. Younger age, absence of diabetes mellitus, higher baseline pc-ASPECTSs, and mTICI score of 2b-3 were associated with better functional outcome in the EVT group.
本研究的作者旨在调查血管内治疗（EVT）与单纯标准药物治疗（SMT）相比，在急性基底动脉闭塞（BAO）且有中度神经功能缺损（美国国立卫生研究院卒中量表[NIHSS]评分10 - 19）患者中的疗效和安全性。
纳入2014年1月至2019年5月期间因急性BAO导致中度神经功能缺损的患者。根据治疗方法将患者分为两组：EVT联合SMT组或单纯SMT组。主要结局是90天时良好的功能结局（改良Rankin量表评分0 - 3），安全性结局是90天时的症状性脑出血（sICH）和死亡率。
共有173例患者有中度神经功能缺损，其中128例接受了EVT治疗，45例仅接受了SMT治疗。与SMT相比，EVT在90天时具有良好结局的比例显著更高（调整后的优势比[aOR]为4.09，95%置信区间[CI]为1.39 - 12.04，p = 0.011）。年龄较小（aOR 0.96，95% CI 0.92 - 0.99，p = 0.017）、无糖尿病（aOR 0.35，95% CI 0.12 - 0.99，p = 0.048）、较高的基线后循环急性卒中预后早期计算机断层扫描评分（pc - ASPECTS；aOR 1.48，95% CI 1.07 - 2.05，p = 0.018）以及改良脑梗死溶栓（mTICI）评分2b - 3（aOR 15.15，95% CI 3.07 - 74.72，p = 0.001）是EVT组良好结局的独立因素。EVT组和SMT组的死亡率和sICH发生率相当。
与单纯SMT相比，EVT可改善结局。年龄较小、无糖尿病、较高的基线pc - ASPECTS评分以及mTICI评分2b - 3与EVT组更好的功能结局相关。
