Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Huancui District, No. 70 Heping Road, Shandong Province, 264200, China.
Clinical College, Weifang Medical University, Weifang, 261000, China.
Neurotherapeutics. 2023 Jan;20(1):220-229. doi: 10.1007/s13311-022-01301-z. Epub 2022 Oct 4.
Prior studies on anterior circulation stroke have demonstrated that the benefits of endovascular treatment (EVT) may be absent in patients with poor collaterals. Our study focused on patients with basilar artery occlusion (BAO) to investigate time-dependent EVT effects according to the posterior circulation collateral score (PC-CS). The BASILAR study was a nationwide prospective Chinese registry of consecutive BAO patients. Patients were divided into groups receiving standard medical therapy alone (SMT group) or SMT plus EVT (EVT group). Restricted cubic spline analyses (RCSA) were performed to explore the nonlinear and linear relationships between EVT time and outcomes for different PC-CS. We included 828 patients with acute BAO. Compared with the poor collateral (PC-CS 0-3), the adjusted odds ratio of favorable outcome was 1.311 in patients with moderate (PC-CS 4-5) (95% CI, 0.781-2.201) and 1.899 with good (PC-CS 6-10) collateral (1.125-3.207) for EVT. RCSA revealed that in patients with PC-CS 0-3, the favorable outcome probability after EVT significantly decreased to 10% within 6 h and stabilized thereafter (P = 0.035), while in patients with moderate and good collateral, the probability was maintained at approximately 30% and 40% respectively, even beyond 6 h (all P > 0.05). Among patients with BAO, good collateral circulation was independently associated with improved outcomes along with the usage of thrombectomy. Patients with poor collaterals should receive EVT as early as possible, especially within 6 h of symptom onset, while the time window may be extended in patients with moderate and good collaterals. Unique identifier: ChiCTR1800014759.
先前的前循环卒中研究表明，血管内治疗（EVT）的益处可能在侧支循环不良的患者中不存在。我们的研究集中在基底动脉闭塞（BAO）患者身上，根据后循环侧支评分（PC-CS）来研究时间依赖性 EVT 效果。BASILAR 研究是一项全国性的连续 BAO 患者前瞻性中国登记研究。患者分为仅接受标准药物治疗的组（SMT 组）或 SMT 加 EVT 的组（EVT 组）。进行受限立方样条分析（RCSA）以探索不同 PC-CS 下 EVT 时间与结局之间的非线性和线性关系。我们纳入了 828 例急性 BAO 患者。与侧支循环不良（PC-CS 0-3）相比，中侧支（PC-CS 4-5）患者的良好结局调整优势比为 1.311（95%CI，0.781-2.201），良好侧支（PC-CS 6-10）患者为 1.899（1.125-3.207）。RCSA 显示，在 PC-CS 0-3 的患者中，EVT 后良好结局的概率在 6 小时内显著下降至 10%，此后稳定（P=0.035），而在中侧支和良好侧支患者中，该概率分别维持在约 30%和 40%，即使超过 6 小时（均 P>0.05）。在 BAO 患者中，良好的侧支循环与血栓切除术的使用与改善结局相关。侧支循环不良的患者应尽快接受 EVT，尤其是在症状发作后 6 小时内，而在中侧支和良好侧支患者中，时间窗可能会延长。独特标识符：ChiCTR1800014759。
