Hu Jinrong, He Wencheng, Zheng Bo, Huang Fang, Lv Kefeng, Liao Jiasheng, Chen Zhao, Jiang He, Wang Kuiyun, Wang Hongjun, Lei Yang, Liao Jiachuan, Sang Hongfei, Liu Shuai, Luo Weidong, Sun Ruidi, Yang Jie, Huang Jiacheng, Song Jiaxing, Li Fengli, Zi Wenjie, Long Chen, Yang Qingwu
Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Neurology, Guiping People's Hospital, Guiping, China.
Front Neurol. 2022 Apr 25;13:830705. doi: 10.3389/fneur.2022.830705. eCollection 2022.
This study aimed to investigate the association between the hyperdense basilar artery sign (HBAS) on non-enhanced computed tomography (CT) and clinical outcomes in patients with acute basilar artery occlusion (BAO) who underwent endovascular treatment (EVT).
Eligible patients who underwent EVT due to acute BAO between January 2014 and May 2019 were divided into two groups based on HBAS. HBAS was assessed by two neuroradiologists using five grades on nonenhanced CT. The primary outcome was a favorable functional outcome (defined as a modified Rankin Scale [mRS] of 0-3) at 90 days. Secondary outcomes included successful recanalization and mortality within 90 days.
Among 829 patients with BAO as assessed with CT angiography, magnetic resonance angiography, or digital subtraction angiography, 643 patients were treated with EVT. Of these, 51.32% (330/643) had HBAS. Patients with HBAS were older and had more severe neurological deficits and a higher frequency of atrial fibrillation than those without HBAS. There was no significant difference in favorable outcome (adjusted odds ratio [aOR]: 1.354, 95% confidence interval [CI]: 0.906-2.024; = 0.14), successful recanalization (aOR: 0.926, 95% CI: 0.616--1.393; = 0.71), and mortality (aOR: 1.193, 95% CI: 0.839-1.695; = 0.33) between patients with or without HBAS. Subgroup analysis showed that the HBAS predicted a favorable outcome in patients aged <60 years (aOR: 2.574, 95% CI: 1.234-5.368; = 0.01) and patients with vertebral artery-V4 segment occlusion (aOR: 3.738, 95% CI: 1.212-11.530; = 0.02). In patients with HBAS, the baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation-Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS), and stent retriever were associated with successful recanalization.
Our study did not find a significant association between HBAS and favorable outcomes and successful recanalization in patients with BAO who underwent EVT. Moreover, large prospective studies are warranted to further investigate this relationship.
本研究旨在探讨急性基底动脉闭塞（BAO）患者在接受血管内治疗（EVT）时，非增强计算机断层扫描（CT）上的高密度基底动脉征（HBAS）与临床结局之间的关联。
将2014年1月至2019年5月因急性BAO接受EVT的符合条件的患者根据HBAS分为两组。两名神经放射科医生在非增强CT上使用五个等级对HBAS进行评估。主要结局是90天时良好的功能结局（定义为改良Rankin量表[mRS]评分为0 - 3）。次要结局包括90天内成功再通和死亡率。
在通过CT血管造影、磁共振血管造影或数字减影血管造影评估的829例BAO患者中，643例接受了EVT治疗。其中，51.32%（330/643）有HBAS。与无HBAS的患者相比，有HBAS的患者年龄更大，神经功能缺损更严重，房颤发生率更高。有无HBAS的患者在良好结局（调整优势比[aOR]：1.354，95%置信区间[CI]：0.906 - 2.024；P = 0.14）、成功再通（aOR：0.926，95%CI：0.616 - 1.393；P = 0.71）和死亡率（aOR：1.193，95%CI：0.839 - 1.695；P = 0.33）方面无显著差异。亚组分析显示，HBAS在年龄<60岁的患者（aOR：2.574，95%CI：1.234 - 5.368；P = 0.01）和椎动脉V4段闭塞的患者（aOR：3.738，95%CI：1.212 - 11.530；P = 0.02）中预测良好结局。在有HBAS的患者中，基线美国国立卫生研究院卒中量表（NIHSS）评分、后循环 - 急性卒中预后早期计算机断层扫描评分（pc - ASPECTS）和支架取栓器与成功再通相关。
我们的研究未发现接受EVT的BAO患者中HBAS与良好结局及成功再通之间存在显著关联。此外，需要大型前瞻性研究进一步探讨这种关系。
