后循环闭塞患者机械取栓的临床评估：一项回顾性研究。
Clinical evaluation of mechanical thrombectomy for patients with posterior circulation occlusion: A retrospective study.
作者信息
Takano Yuki, Koyanagi Masaomi, Takamatsu Takateru, Tokuda Masanori, Tomita Hikari, Yoshimoto Mai, Sakisuka Ryo, Kawade Satohiro, Naramoto Yuji, Nishii Rikuo, Yamamoto Yasuhiro, Nakajima Kota, Teranishi Kunimasa, Fukui Nobuyuki, Sunohara Tadashi, Fukumitsu Ryu, Takeda Junichi, Ohara Nobuyuki, Goto Masanori, Imamura Hirotoshi, Sakai Nobuyuki, Ohta Tsuyoshi
机构信息
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
出版信息
Clin Neurol Neurosurg. 2024 Feb;237:108133. doi: 10.1016/j.clineuro.2024.108133. Epub 2024 Feb 1.
OBJECTIVE
Although consensus has been reached regarding the use of mechanical thrombectomy for acute large anterior circulation occlusion, its effectiveness in patients with posterior circulation occlusion remains unclear. This study aimed to establish the determining factors for good clinical outcomes of mechanical thrombectomy for posterior circulation occlusion.
METHODS
We extracted cases of acute large vessel occlusion (LVO) in the posterior circulation from a database comprising 536 patients who underwent mechanical thrombectomy at our hospital between April 2015 and March 2021.
RESULTS
Fifty-two patients who underwent mechanical thrombectomy for LVO in the posterior circulation were identified. Five patients with simultaneous occlusion of the anterior and posterior circulation were excluded; finally, 47 patients were included in this study. The median patient age was 78 years, and 36% of the patients were women. The median National Institutes of Health Stroke Scale (NIHSS) score on admission was 31, the median posterior circulation-Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS) was 8, and the median Basilar Artery on Computed Tomography Angiography (BATMAN) score was 6. The rate of good recanalization (Thrombolysis in Cerebral Infarction scale grades 2b and 3) was 96%, and a good prognosis (modified Rankin Scale score of 0-2 at 90 days) was achieved in 19 patients (40%). The median pc-ASPECTS was significantly higher in the good prognosis group than in the poor prognosis group (10 vs. 7; p = 0.007). The median NIHSS score at presentation was significantly lower in the good prognosis group than in the poor prognosis group (17 vs. 34; p = 0.02). The median BATMAN score was significantly higher in the good prognosis group than in the poor prognosis group (8 vs. 3.5; p = 0.0002). Multivariate analysis showed that an NIHSS score ≦ 20 at presentation was the only independent factor for good prognoses.
CONCLUSION
The prognosis of mechanical thrombectomy for posterior circulation LVO was better in patients with lower NIHSS scores at presentation.
目的
尽管对于急性大脑前循环闭塞采用机械取栓术已达成共识，但其对后循环闭塞患者的有效性仍不明确。本研究旨在确定后循环闭塞机械取栓术取得良好临床疗效的决定因素。
方法
我们从一个数据库中提取了后循环急性大血管闭塞（LVO）的病例，该数据库包含2015年4月至2021年3月期间在我院接受机械取栓术的536例患者。
结果
确定了52例接受后循环LVO机械取栓术的患者。排除5例同时存在前循环和后循环闭塞的患者；最终，47例患者纳入本研究。患者年龄中位数为78岁，36%为女性。入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数为31，后循环-艾伯塔卒中项目早期计算机断层扫描评分（pc-ASPECTS）中位数为8，计算机断层扫描血管造影基底动脉评分（BATMAN）中位数为6。良好再通率（脑梗死溶栓分级2b和3级）为96%，19例患者（40%）获得良好预后（90天时改良Rankin量表评分为0-2）。良好预后组的pc-ASPECTS中位数显著高于预后不良组（10对7；p = 0.007）。良好预后组就诊时的NIHSS评分中位数显著低于预后不良组（17对34；p = 0.02）。良好预后组的BATMAN评分中位数显著高于预后不良组（8对3.5；p = 0.0002）。多因素分析显示，就诊时NIHSS评分≤20是良好预后的唯一独立因素。
结论
后循环LVO机械取栓术在就诊时NIHSS评分较低的患者中预后较好。
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