Yang Jie, Li Fengli, Qiu Zhongming, Wang Yan, Luo Jun, Wu Youlin, Zeng Guoyong, Wan Yue, Liu Shuai, Yue Chengsong, Song Jiaxing, Luo Weidong, Liu Chang, Li Linyu, Sun Ruidi, Huang Jiacheng, Sang Hongfei, Zhao Chenhao, Yang Qingwu, Zi Wenjie
1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing.
2Department of Neurology, Chengdu Fifth People's Hospital, Chengdu.
J Neurosurg. 2022 May 27;138(1):205-214. doi: 10.3171/2022.4.JNS22355. Print 2023 Jan 1.
The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) plus standard medical treatment (SMT) in patients with acute basilar artery occlusion (BAO) within 6 hours of the estimated occlusion time, based on a Chinese population.
The authors selected patients from the Endovascular Treatment of Acute Basilar Artery Occlusion Study (BASILAR) registry, which was a nationwide prospective registry, within 6 hours after the estimated time of onset of a stroke in acute BAO. Patients were divided into the SMT-alone group or the EVT+SMT group according to treatment modalities. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score between 0 and 3 at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage.
The authors assessed 590 patients for eligibility. Of these patients, 127 received SMT alone and 463 were treated with EVT plus SMT. EVT was associated with a higher rate of a favorable functional outcome (adjusted OR 3.804, 95% CI 1.890-7.658; p < 0.001) and a lower proportion of deaths at 90 days (adjusted OR 0.364, 95% CI 0.223-0.594; p < 0.001). Lower age (adjusted OR 0.978, 95% CI 0.960-0.997; p = 0.022); lower baseline National Institutes of Health Stroke Scale score (adjusted OR 0.926, 95% CI 0.902-0.950; p < 0.001); higher baseline posterior circulation Alberta Stroke Program Early CT Score (adjusted OR 1.681, 95% CI 1.424-1.984; p < 0.001); absence of diabetes mellitus (adjusted OR 0.482, 95% CI 0.267-0.871; p = 0.016); and modified Thrombolysis in Cerebral Infarction scores 2b-3 (adjusted OR 5.117, 95% CI 2.304-11.367; p < 0.001) were independent factors for a favorable outcome in the EVT+SMT group.
Based on the study design, patients with acute BAO who received EVT within 6 hours were associated with improved favorable outcome and decreased deaths compared with patients who received SMT. Predictors of desirable outcome in patients undergoing EVT included lower age, lower baseline National Institutes of Health Stroke Scale score, higher baseline posterior circulation Alberta Stroke Program Early CT Score, absence of diabetes mellitus, and modified Thrombolysis in Cerebral Infarction scores 2b-3.
本研究旨在基于中国人群，探讨血管内治疗（EVT）联合标准药物治疗（SMT）对估计闭塞时间6小时内的急性基底动脉闭塞（BAO）患者的疗效和安全性。
作者从急性基底动脉闭塞血管内治疗研究（BASILAR）登记处选取患者，该登记处为全国性前瞻性登记处，选取急性BAO患者中风估计发病时间6小时内的患者。根据治疗方式将患者分为单纯SMT组或EVT+SMT组。主要结局为良好的功能结局，定义为90天时改良Rankin量表评分为0至3分。安全性结局包括90天时的死亡和症状性脑出血。
作者评估了590例患者的 eligibility。其中，127例仅接受SMT，463例接受EVT联合SMT治疗。EVT与更高的良好功能结局发生率相关（调整后的OR为3.804，95%CI为1.890-7.658；p<0.001），且90天时死亡比例更低（调整后的OR为0.364，95%CI为0.223-0.594；p<0.001）。年龄较小（调整后的OR为0.978，95%CI为0.960-0.997；p=0.022）；基线美国国立卫生研究院卒中量表评分较低（调整后的OR为0.926，95%CI为0.902-0.950；p<0.001）；基线后循环阿尔伯塔卒中项目早期CT评分较高（调整后的OR为1.681，95%CI为1.424-1.984；p<0.001）；无糖尿病（调整后的OR为0.482，95%CI为0.267-0.871；p=0.016）；以及改良脑梗死溶栓评分2b-3（调整后的OR为5.117，95%CI为2.304-11.367；p<0.001）是EVT+SMT组良好结局的独立因素。
基于研究设计，与接受SMT的患者相比，6小时内接受EVT的急性BAO患者具有更好的良好结局且死亡减少。接受EVT患者良好结局的预测因素包括年龄较小、基线美国国立卫生研究院卒中量表评分较低、基线后循环阿尔伯塔卒中项目早期CT评分较高、无糖尿病以及改良脑梗死溶栓评分2b-3。
