Chiu Yu-Chen, Yang Jia-Li, Wang Wei-Chun, Huang Hung-Yu, Chen Wei-Liang, Yen Pao-Sheng, Tseng Ying-Lin, Chen Hsiu-Hsueh, Tsai Sheng-Ta
Department of Neurology, An Nan Hospital, China Medical University, Tainan 709204, Taiwan.
Department of Anesthesiology, China Medical University Hospital, Taichung 404332, Taiwan.
World J Clin Cases. 2022 Apr 26;10(12):3677-3685. doi: 10.12998/wjcc.v10.i12.3677.
In a previous study, basilar artery occlusion (BAO) was shown to lead to death or disability in 80% of the patients. The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy, but not all patients benefit from these treatments. Thus, understanding the predictors of outcome before initiating these treatments is of special interest.
To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.
We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019. We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke. A neurologist reviewed every case, and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included. We then analyzed the patients' characteristics and factors related to the 90-d outcome.
We identified a total of 99 patients as real BAO cases. Of these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0-3). Moreover, 72 patients received intra-arterial thrombectomy, while 13 patients received intravenous tissue-type plasminogen activator treatment. We observed a favorable outcome in 33.3% of the cases and an unfavorable outcome in 66.7% of the cases. We found that the initial National Institutes of Health Stroke Scale (NIHSS) score and several BAO symptoms, including impaired consciousness, tetraparesis, and pupillary abnormalities, were significantly associated with an unfavorable outcome ( < 0.05), while cerebellar symptoms were associated with a favorable outcome ( < 0.05). In the receiver operating characteristic (ROC) analysis, the areas under the ROC curve of initial NIHSS score, impaired consciousness, tetraparesis, cerebellar symptoms, and pupillary abnormalities were 0.836, 0.644, 0.727, 0.614, and 0.614, respectively. Initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.
The most important predictor of an unfavorable outcome was the initial NIHSS score. BAO symptoms, including tetraparesis, impaired consciousness, and pupillary abnormality were also related to an unfavorable outcome.
在之前的一项研究中，基底动脉闭塞（BAO）在80%的患者中导致死亡或残疾。BAO急性期患者的治疗包括溶栓和动脉内血栓切除术，但并非所有患者都能从这些治疗中获益。因此，在开始这些治疗之前了解预后的预测因素具有特殊意义。
确定亚洲人群中BAO患者90天临床结局的相关预测因素。
我们对2015年至2019年期间入住三级卒中中心的患者进行了回顾性病例审查。我们使用国际疾病分类第10版标准来确定后循环卒中病例。一名神经科医生对每个病例进行了审查，纳入了符合基底动脉国际合作研究中定义标准的患者。然后我们分析了患者的特征以及与90天结局相关的因素。
我们共确定了99例真正的BAO病例。在这些患者中，33例（33.3%）在90天时预后良好（改良Rankin量表评分：0 - 3）。此外，72例患者接受了动脉内血栓切除术，13例患者接受了静脉注射组织型纤溶酶原激活剂治疗。我们观察到33.3%的病例预后良好，66.7%的病例预后不良。我们发现初始美国国立卫生研究院卒中量表（NIHSS）评分以及几种BAO症状，包括意识障碍、四肢瘫和瞳孔异常，与不良结局显著相关（P < 0.05），而小脑症状与良好结局相关（P < 0.05）。在受试者工作特征（ROC）分析中，初始NIHSS评分、意识障碍、四肢瘫、小脑症状和瞳孔异常的ROC曲线下面积分别为0.836、0.644、0.727、0.614和0.614。与BAO症状相比，初始NIHSS评分显示出更高的曲线下面积（0.836）。
不良结局的最重要预测因素是初始NIHSS评分。包括四肢瘫、意识障碍和瞳孔异常在内的BAO症状也与不良结局相关。
