Gwak Dong-Seok, Choi WooChan, Kim Yong-Won, Kang Dong-Hun, Son Wonsoo, Hwang Yang-Ha
Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.
Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea.
Front Neurol. 2022 May 10;13:878638. doi: 10.3389/fneur.2022.878638. eCollection 2022.
Regional eloquence of brainstem structures may contribute to neurological status in basilar artery occlusion (BAO) stroke. The corticospinal tract (CST) which is vulnerable to BAO is important for motor activity. This study investigated the impact of CST salvage on outcomes and its associated factors in patients with BAO treated with thrombectomy.
We retrospectively investigated 88 patients with BAO admitted ≤24 h after onset and presented with motor deficits and who underwent thrombectomy. Patients with a pre-stroke modified Rankin Scale (mRS) score of 4-5 who did not undergo baseline brain computed tomography angiography were excluded. CST salvage was evaluated using follow-up imaging (magnetic resonance imaging [MRI] or computed tomography when MRI was not available) after thrombectomy. A good outcome was defined as a 3-month mRS score of ≤2 or 3 if a patient's pre-stroke mRS score was 3. The associations between CST salvage and outcomes and clinical parameters were analyzed using logistic regression analyses.
Thirty-nine (44.3%) patients had CST salvage and the same number of patients had good outcomes. CST salvage was independently associated with a good outcome [adjusted odds ratio (aOR): 18.52, 95% confidence interval (CI): 4.31-79.67, < 0.001]. After adjusting for confounders, atrial fibrillation (aOR: 3.92, 95% CI: 1.18-13.00, = 0.026), location of occlusion (mid-BAO; aOR: 0.21, 95% CI: 0.06-0.72, = 0.013), length of occlusion (involved segment of BAO <2; aOR: 4.77, 95% CI: 1.30-17.59, = 0.019), and onset-to-puncture-time ≤180 min (aOR: 4.84, 95% CI: 1.13-20.75, = 0.034) were significantly associated with CST salvage.
CST salvage was associated with good functional outcomes in patients with BAO treated with thrombectomy. The presence of atrial fibrillation, location and length of BAO may predict CST salvage after thrombectomy, and rapid treatment with thrombectomy may protect this eloquent tract in these patients.
脑干结构的局部功能对基底动脉闭塞（BAO）性卒中的神经功能状态可能有影响。易受BAO影响的皮质脊髓束（CST）对运动活动很重要。本研究调查了CST挽救对接受血栓切除术的BAO患者预后的影响及其相关因素。
我们回顾性研究了88例发病后≤24小时入院、有运动功能缺损且接受了血栓切除术的BAO患者。排除卒中前改良Rankin量表（mRS）评分为4 - 5且未进行基线脑计算机断层血管造影的患者。血栓切除术后使用随访成像（磁共振成像[MRI]，若无法进行MRI则使用计算机断层扫描）评估CST挽救情况。若患者卒中前mRS评分为3，则良好预后定义为3个月mRS评分≤2或3。使用逻辑回归分析CST挽救与预后及临床参数之间的关联。
39例（44.3%）患者实现了CST挽救，且有相同数量的患者获得了良好预后。CST挽救与良好预后独立相关[调整后的优势比（aOR）：18.52，95%置信区间（CI）：4.31 - 79.67，P < 0.001]。在调整混杂因素后，心房颤动（aOR：3.92，95% CI：1.18 - 13.00，P = 0.026）、闭塞位置（BAO中段；aOR：0.21，95% CI：0.06 - 0.72，P = 0.013）、闭塞长度（BAO受累节段<2；aOR：4.77，95% CI：1.30 - 17.59，P = 0.019）以及发病至穿刺时间≤180分钟（aOR：4.84，95% CI：1.13 - 20.75，P = 0.034）与CST挽救显著相关。
CST挽救与接受血栓切除术的BAO患者良好的功能预后相关。心房颤动的存在、BAO的位置和长度可能预测血栓切除术后的CST挽救情况，而血栓切除术的快速治疗可能保护这些患者的这一功能区。
