Feil Katharina, Berndt Maria Teresa, Wunderlich Silke, Maegerlein Christian, Bernkopf Kathleen, Zimmermann Hanna, Herzberg Moriz, Tiedt Steffen, Küpper Clemens, Wischmann Johannes, Schönecker Sonja, Dimitriadis Konstantin, Liebig Thomas, Dieterich Marianne, Zimmer Claus, Kellert Lars, Boeckh-Behrens Tobias
Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany.
Department of Neurology and Stroke, Eberhard-Karls University Tübingen/Universitätsklinikum Tübingen (UKT), Tübingen, Germany.
Eur J Neurol. 2023 May;30(5):1293-1302. doi: 10.1111/ene.15694. Epub 2023 Feb 22.
Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice.
Patients enrolled between June 2015 and December 2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3), substantial neurological improvement (≥8-point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge ≤1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0-2).
Out of 6635 GSR-ET patients, 640 (9.6%) patients (age 72.2 ± 13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3-month follow-up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76-5.23) and successful reperfusion (OR 4.92, 95% CI 1.15-21.11), while the effect of time between symptom onset and reperfusion seemed to be small.
Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact.
基底动脉闭塞（BAO）所致急性缺血性卒中引发的中风最为严重，预后较差。关于血管内血栓切除术治疗BAO疗效的数据较为匮乏。因此，在本研究中，我们对常规临床实践中BAO患者的治疗情况进行了分析。
对2015年6月至2019年12月纳入德国卒中登记 - 血管内治疗（GSR - ET）的患者进行分析。主要结局指标为成功再灌注（脑梗死改良溶栓[mTICI]评分2b - 3）、显著神经功能改善（从入院到出院美国国立卫生研究院卒中量表[NIHSS]评分降低≥8分或出院时NIHSS评分≤1）以及3个月时良好的功能结局（改良Rankin量表[mRS]评分0 - 2）。
在6635例GSR - ET患者中，640例（9.6%）患者（年龄72.2±13.3岁，43.3%为女性）发生BAO（NIHSS评分中位数[四分位间距]为17[8, 27]）。成功再灌注率为88.4%。出院时显著神经功能改善率为45.5%。在3个月随访时，31.1%的患者观察到良好的临床结局，死亡率为39.2%。mTICI评分3组与mTICI评分2b组的分析显示，mTICI评分3组的结局明显更好（38.9%对24.4%；p = 0.005）。良好功能结局的最强预测因素是静脉溶栓（IVT）治疗（比值比[OR]3.04，95%置信区间[CI]1.76 - 5.23）和成功再灌注（OR 4.92，95%CI 1.15 - 21.11），而症状发作至再灌注的时间影响似乎较小。
BAO的急性再灌注策略在日常实践中较为常见，且能实现较高的成功再灌注率、神经功能改善率和良好的功能结局。我们的数据表明，除IVT治疗外，成功尤其是完全再灌注（mTICI评分3）强烈预示良好结局，而症状发作时间的影响似乎较小。
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