Ryu Jae-Chan, Kwon Boseong, Song Yunsun, Lee Deok Hee, Chang Jun Young, Kang Dong-Wha, Kwon Sun U, Kim Jong S, Kim Bum Joon
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Front Neurol. 2023 Apr 25;14:1161198. doi: 10.3389/fneur.2023.1161198. eCollection 2023.
Top-of-basilar artery occlusion (TOB) is one of the most devastating strokes despite successful mechanical thrombectomy (MT). We aimed to investigate the impact of initial low cerebellum perfusion delay on the outcomes of TOB treated with MT.
We included patients who underwent MT for TOB. Clinical and peri-procedural variables were obtained. Perfusion delay in the low cerebellum was defined as (1) time-to-maximum (Tmax) >10 s lesions or (2) relative time-to-peak (rTTP) map >9.5 s with a diameter of ≥6 mm in the low cerebellum. The good functional outcome was defined as the achievement of a modified Rankin Scale score of 0-3 at 3 months after stroke.
Among the 42 included patients, 24 (57.1%) patients showed perfusion delay in the low cerebellum. The admission National Institutes of Health Stroke Scale (NIHSS) score was significantly higher in those with perfusion delay [17 (12-24) vs. 8 (6-15), = 0.002]. Accordingly, the proportion of good functional outcomes was lower in those with perfusion delay than in those without [5 (20.8%) vs. 13 (72.2%), = 0.003]. From the multivariable analysis, the admission NIHSS score [odds ratio (OR) = 0.86, 95% confidence intervals (CIs) = 0.75-0.98, = 0.021] and low cerebellum perfusion delay (OR = 0.18, 95% Cis = 0.04-0.86, = 0.031) were independently associated with the 3-month functional outcomes.
We found that initial perfusion delay proximal to TOB in the low cerebellum might be a predictor for poor functional outcomes in TOB treated with MT.
尽管成功进行了机械取栓术（MT），基底动脉尖闭塞（TOB）仍是最具破坏性的中风类型之一。我们旨在研究初始小脑低灌注延迟对接受MT治疗的TOB患者预后的影响。
我们纳入了接受MT治疗TOB的患者。获取临床和围手术期变量。小脑低灌注延迟定义为：（1）小脑低灌注区域最大时间（Tmax）>10秒的病变；或（2）小脑低灌注区域相对达峰时间（rTTP）图>9.5秒且直径≥6毫米。良好功能预后定义为中风后3个月改良Rankin量表评分为0 - 3分。
在纳入的42例患者中，24例（57.1%）患者出现小脑低灌注延迟。有灌注延迟的患者入院时美国国立卫生研究院卒中量表（NIHSS）评分显著更高[17（12 - 24）对8（6 - 15），P = 0.002]。因此，有灌注延迟的患者良好功能预后的比例低于无灌注延迟的患者[5例（20.8%）对13例（72.2%），P = 0.003]。多变量分析显示，入院时NIHSS评分[比值比（OR）= 0.86，95%置信区间（CI）= 0.75 - 0.98，P = 0.021]和小脑低灌注延迟（OR = 0.18，95% CI = 0.04 - 0.86，P = 0.031）与3个月功能预后独立相关。
我们发现TOB近端初始小脑低灌注延迟可能是接受MT治疗的TOB患者功能预后不良的预测因素。
