Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China.
J Neurointerv Surg. 2023 Nov;15(e2):e161-e165. doi: 10.1136/jnis-2022-019409. Epub 2022 Oct 3.
The effects of secondary collateral compensation on outcomes remain unclear in patients with acute basilar artery occlusion (BAO) after endovascular treatment (EVT). This study aimed to evaluate the benefits of the anastomosis between the posterior inferior cerebellar artery (PICA) and the superior cerebellar artery (SCA) in BAO after EVT.
This cohort study was conducted using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry. Patients with acute BAO and treated with EVT were included. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (SICH) and 90-day mortality.
Of the 646 patients included in the study, 196 (30.3%) patients had a PICA-SCA anastomosis. The PICA-SCA anastomosis was significantly associated with independent functional outcome at 90 days (67/196 (34.2%) vs 109/450 (24.2%), adjusted OR (aOR) 1.80 (95% CI 1.13 to 2.86), p=0.01) and was significantly associated with a decreased rate of SICH (40/442 (9.0%) vs 5/193 (2.6%), aOR 0.29 (95% CI 0.11 to 0.76), p=0.01). No significant difference was found between PICA-SCA anastomosis and 90-day mortality (219/450 (48.7%) vs 80/196 (40.8%), aOR 0.72 (95% CI 0.48 to 1.08), p=0.11). Subgroup analysis showed that the association between independent functional outcome and PICA-SCA anastomosis was strongest in patients with middle BAO (27/77 (35.1%) vs 22/118 (18.6%), aOR 2.64 (95% CI 1.13 to 6.15), p=0.03).
The PICA-SCA anastomosis is significantly associated with better functional outcomes in patients with acute BAO after EVT, especially in those with middle BAO.
在急性基底动脉闭塞（BAO）患者接受血管内治疗（EVT）后，次级侧支代偿对结局的影响仍不清楚。本研究旨在评估急性 BAO 患者 EVT 后后下小脑动脉（PICA）与小脑上动脉（SCA）吻合的益处。
这是一项使用血管内治疗急性基底动脉闭塞研究登记处的数据进行的队列研究。纳入了急性 BAO 并接受 EVT 治疗的患者。主要结局为 90 天时改良 Rankin 量表评分为 0-2 分。安全性结局包括症状性颅内出血（SICH）和 90 天死亡率。
在纳入的 646 例患者中，196 例（30.3%）患者存在 PICA-SCA 吻合。PICA-SCA 吻合与 90 天的独立功能结局显著相关（67/196（34.2%）与 109/450（24.2%），调整后的 OR（aOR）1.80（95%CI 1.13-2.86），p=0.01），且与 SICH 发生率降低显著相关（40/442（9.0%）与 5/193（2.6%），aOR 0.29（95%CI 0.11-0.76），p=0.01）。PICA-SCA 吻合与 90 天死亡率之间无显著差异（219/450（48.7%）与 80/196（40.8%），aOR 0.72（95%CI 0.48-1.08），p=0.11）。亚组分析显示，在中脑 BAO 患者中，独立功能结局与 PICA-SCA 吻合之间的关联最强（27/77（35.1%）与 22/118（18.6%），aOR 2.64（95%CI 1.13-6.15），p=0.03）。
在急性 BAO 患者接受 EVT 后，PICA-SCA 吻合与更好的功能结局显著相关，特别是在中脑 BAO 患者中。
