Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China.
Neurosurgery. 2023 May 1;92(5):1006-1012. doi: 10.1227/neu.0000000000002313. Epub 2022 Dec 29.
It is estimated that >50% of acute basilar artery occlusion (ABAO) patients with successful reperfusion after endovascular treatment (EVT) have futile recanalization. However, few studies investigated the reasons behind this.
To identify the factors associated with futile recanalization in ABAO after successful reperfusion.
We recruited patients with successful reperfusion (expanded Thrombolysis In Cerebral Infarction score of ≥2b) after EVT from the Basilar Artery Occlusion Study registry. Patients were divided into meaningful recanalization (90-day modified Rankin Scale 0-3) and futile recanalization (90-day modified Rankin Scale 4-6) groups. Multivariable logistic regression analyses were used to identify the predictors of futile recanalization.
A total of 522 patients with successful reperfusion were selected. Of these, 328 patients had futile recanalization and 194 had meaningful recanalization. Multivariable logistic regression shows that higher neutrophil-to-lymphocyte ratio ( P = .01), higher baseline National Institutes of Health Stroke Scale score ( P < .001), longer puncture to recanalization time ( P = .02), lower baseline posterior circulation Alberta Stroke Program Early CT score ( P < .001), lower posterior circulation collateral score ( P = .02), incomplete reperfusion ( P < .001), and diabetes mellitus ( P < .001) were predictors of futile recanalization.
Higher neutrophil-to-lymphocyte ratio, longer puncture to recanalization time, incomplete reperfusion, stroke severity, lower baseline posterior circulation Alberta Stroke Program Early CT score, poor collaterals, and diabetes mellitus were independent predictors of futile recanalization in patients with ABAO with successful reperfusion after EVT. Moreover, multiple stent retriever passes were associated with a high proportion of futile recanalization in patients with late time windows.
据估计，血管内治疗（EVT）后成功再通的急性基底动脉闭塞（ABAO）患者中，有>50%的患者再通是无效的。然而，很少有研究探讨其背后的原因。
确定 EVT 后成功再通的 ABAO 患者无效再通的相关因素。
我们从基底动脉闭塞研究登记处招募了 EVT 后成功再通（扩展脑梗死溶栓评分≥2b）的患者。将患者分为有意义再通（90 天改良 Rankin 量表 0-3 分）和无效再通（90 天改良 Rankin 量表 4-6 分）两组。采用多变量逻辑回归分析确定无效再通的预测因素。
共纳入 522 例成功再通的患者，其中 328 例患者再通无效，194 例患者再通有意义。多变量逻辑回归显示，较高的中性粒细胞与淋巴细胞比值（P=0.01）、较高的基线国立卫生研究院卒中量表评分（P<0.001）、较长的穿刺至再通时间（P=0.02）、较低的基线后循环 Alberta 卒中项目早期 CT 评分（P<0.001）、较低的后循环侧支评分（P=0.02）、不完全再通（P<0.001）和糖尿病（P<0.001）是 EVT 后 ABAO 患者无效再通的预测因素。
较高的中性粒细胞与淋巴细胞比值、较长的穿刺至再通时间、不完全再通、卒中严重程度、较低的基线后循环 Alberta 卒中项目早期 CT 评分、较差的侧支循环和糖尿病是 EVT 后成功再通的 ABAO 患者无效再通的独立预测因素。此外，多次支架取栓与晚期时间窗患者无效再通比例较高有关。
