Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, China.
Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, Sichuan, China.
J Neurointerv Surg. 2023 Aug;15(8):808-813. doi: 10.1136/jnis-2022-019112. Epub 2022 Aug 19.
Locked-in syndrome (LiS) is a rare and devastating condition in patients with acute basilar artery occlusion. However, the benefits of endovascular treatment (EVT) for LiS remain unclear.
To assess the outcomes associated with EVT and identify the factors associated with outcomes of LiS.
We used the data of the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry (BASILAR) from 47 tertiary stroke centers in China. The included patients had LiS and received EVT or standard medical treatment (SMT) alone. The primary outcome was improvement in the modified Rankin Scale (mRS) score at 90 days.
Among the 120 patients with LiS, 92 (76.7%) received EVT and 28 (23.3%) received SMT. Compared with SMT, EVT was associated with improved mRS score (common OR (cOR)=2.68 (95% CI 1.16 to 6.20); p=0.02) and decreased mortality (aOR=0.35 (95% CI 0.13 to 0.90); p=0.03). Moreover, the benefit of EVT for LiS was sustained for at least 1 year (p=0.008). Higher baseline posterior circulation Alberta Stroke Prognosis Early CT Score (pc-ASPECTS, aOR=2.04 (95% CI 1.34 to 3.10); p<0.001) and absence of pneumonia (aOR=0.26 (95% CI 0.08 to 0.90); p=0.03) were significantly associated with favorable functional outcome at 90 days in patients who received EVT, while lower pc-ASPECTS (aOR=0.52 (95% CI 0.36 to 0.76); p<0.001) was associated with increased 90-day mortality.
This study found that EVT was associated with favorable functional outcomes and decreased mortality among patients with LiS. Baseline pc-ASPECTS and pneumonia were independent predictors of outcomes.
闭锁综合征（LiS）是急性基底动脉闭塞患者中一种罕见且严重的病症。然而，血管内治疗（EVT）对 LiS 的益处尚不清楚。
评估 EVT 相关结局，并确定与 LiS 结局相关的因素。
我们使用了来自中国 47 家三级卒中中心的血管内治疗急性基底动脉闭塞研究登记处（BASILAR）的数据。纳入的患者患有 LiS，并单独接受 EVT 或标准药物治疗（SMT）。主要结局是 90 天时改良 Rankin 量表（mRS）评分的改善。
在 120 例 LiS 患者中，92 例（76.7%）接受了 EVT，28 例（23.3%）接受了 SMT。与 SMT 相比，EVT 与改善的 mRS 评分相关（常见比值比（cOR）=2.68（95%CI 1.16 至 6.20）；p=0.02），死亡率降低（aOR=0.35（95%CI 0.13 至 0.90）；p=0.03）。此外，EVT 对 LiS 的益处至少持续 1 年（p=0.008）。较高的基线后循环 Alberta 卒中预后早期 CT 评分（pc-ASPECTS，aOR=2.04（95%CI 1.34 至 3.10）；p<0.001）和无肺炎（aOR=0.26（95%CI 0.08 至 0.90）；p=0.03）与接受 EVT 的患者 90 天时的良好功能结局显著相关，而较低的 pc-ASPECTS（aOR=0.52（95%CI 0.36 至 0.76）；p<0.001）与 90 天死亡率增加相关。
本研究发现，EVT 与 LiS 患者的良好功能结局和降低死亡率相关。基线 pc-ASPECTS 和肺炎是结局的独立预测因素。
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