Department of Neurology, Guangdong Second Provincial General Hospital.
The Second School of Clinical Medicine, Southern Medical University.
Int J Surg. 2023 Aug 1;109(8):2303-2311. doi: 10.1097/JS9.0000000000000476.
This study aimed to analyze the long-term prognostic factors in acute vertebrobasilar artery occlusion (VBAO) patients treated with endovascular treatment (EVT).
This study was performed using the acute posterior circulation ischemic stroke registry database from 21 stroke centers in 18 cities in China and retrospectively included consecutive patients aged 18 years or older with an acute, symptomatic, radiologically confirmed VBAO who were treated with EVT between December 2015 and December 2018. Favorable clinical outcomes were evaluated by machine-learning methods. A clinical signature was constructed in the training cohort using the least absolute shrinkage and selection operator regression and was validated in the validation cohort.
From 28 potential factors, 7 variables were independent prognostic factors and were included in the model: Modified Thrombolysis in Cerebral Infarction (M) [odds ratio (OR): 2.900; 95% confidence interval [CI]: 1.566-5.370], age (A) (OR, 0.977; 95% CI: 0.961-0.993), National Institutes of Health Stroke Scale (N) (13-27 vs. ≤12: OR, 0.491; 95% CI: 0.275-0.876; ≥28 vs. ≤12: OR, 0.148; 95% CI: 0.076-0.289), atrial fibrillation (A) (OR, 2.383; 95% CI: 1.444-3.933), Glasgow Coma Scale (G) (OR, 2.339; 95% CI: 1.383-3.957), endovascular stent-retriever thrombectomy (E) (stent-retriever vs. aspiration: OR, 0.375; 95% CI: 0.156-0.902), and estimated time of onset of the occlusion to groin puncture (Time) (OR, 0.950; 95% CI: 0.909-0.993) (abbreviated as MANAGE Time). In the internal validation set, this model was well calibrated with good discrimination [C-index (95% CI)=0.790 (0.755-0.826)]. A calculator based on the model can be found online ( http://ody-wong.shinyapps.io/1yearFCO/ ).
Our results indicate that optimizing for EVT, along with specific risk stratification, may improve long-term prognosis. However, a larger prospective study is needed to confirm the findings.
本研究旨在分析接受血管内治疗（EVT）的急性椎基底动脉闭塞（VBAO）患者的长期预后因素。
本研究使用来自中国 18 个城市 21 个卒中中心的急性后循环缺血性卒中登记数据库，回顾性纳入 2015 年 12 月至 2018 年 12 月期间接受 EVT 治疗的年龄在 18 岁及以上的急性、症状性、影像学证实的 VBAO 连续患者。采用机器学习方法评估临床转归。在训练队列中使用最小绝对收缩和选择算子回归构建临床特征，并在验证队列中进行验证。
从 28 个潜在因素中，有 7 个变量是独立的预后因素，被纳入模型：改良脑梗死溶栓（M）[比值比（OR）：2.900；95%置信区间（CI）：1.566-5.370]、年龄（A）（OR，0.977；95%CI：0.961-0.993）、国立卫生研究院卒中量表（N）（13-27 分比≤12 分：OR，0.491；95%CI：0.275-0.876；≥28 分比≤12 分：OR，0.148；95%CI：0.076-0.289）、心房颤动（A）（OR，2.383；95%CI：1.444-3.933）、格拉斯哥昏迷量表（G）（OR，2.339；95%CI：1.383-3.957）、血管内支架取栓术（E）（支架取栓术比抽吸术：OR，0.375；95%CI：0.156-0.902）和闭塞至股动脉穿刺时间（Time）（OR，0.950；95%CI：0.909-0.993）（简称 MANAGE Time）。在内部验证集中，该模型具有良好的校准度和区分度[C 指数（95%CI）=0.790（0.755-0.826）]。基于该模型的计算器可在网上找到（http://ody-wong.shinyapps.io/1yearFCO/）。
我们的结果表明，通过优化 EVT 治疗，并进行特定的风险分层，可能会改善长期预后。然而，需要更大的前瞻性研究来证实这些发现。
