Klail Tomas, Piechowiak Eike I, Krug Nadja, Maegerlein Christian, Maus Volker, Fischer Sebastian, Lobsien Donald, Pielenz Daniel, Styczen Hanna, Deuschl Cornelius, Thormann Maximilian, Diamandis Elie, Heldner Mirjam R, Kaesmacher Johannes, Mordasini Pasquale
Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland.
Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Interv Neuroradiol. 2024 Apr 5:15910199241240045. doi: 10.1177/15910199241240045.
Acute basilar artery occlusion (BAO) is a severe disease that is associated with an 85% mortality rate if untreated. Several studies have analyzed the use of mechanical thrombectomy (MT) in the different scenarios of BAO. However, the results remain conflicting and the role of MT as standard of care for vertebrobasilar tandem occlusions (VBTO) has not been confirmed. Our goal was to assess technical feasibility, safety, and functional outcome of endovascular treatment of VBTO in comparison to isolated BAO (IBAO).
We retrospectively reviewed all prospectively collected patients with acute BAO from six tertiary centers between September 2016 and November 2021. Patients were subsequently divided into two groups: VBTO and IBAO. Baseline data, procedural details, and outcomes were compared between groups.
A total of 190 patients were included, 55 presenting with a VBTO and 135 with IBAO. Successful recanalization was equally common in both groups (89.1% and 86.0%). Rates of favorable functional outcome (modified Rankin Scale: 0-2) were higher in patients with VBTO compared to IBAO (36.4% vs. 25.2%, p = 0.048) and mortality was lower (29.1% vs. 33.3%). However, these associations faded after adjustment for confounders (adjusted odds ratio [aOR] 0.86, 95% CI 0.35-2.05; aOR 0.93, 95% CI 0.35-2.45). Rates of symptomatic intracranial hemorrhage did not differ between the groups (VBTO: 7.3% vs. IBAO: 4.2%; p = 0.496).
Endovascular treatment of VBTO is technically feasible and safe with similar rates of successful recanalization, favorable functional outcome, and mortality to those in patients with IBAO.
急性基底动脉闭塞（BAO）是一种严重疾病，若不治疗，死亡率高达85%。多项研究分析了机械取栓术（MT）在不同BAO情况下的应用。然而，结果仍存在冲突，MT作为椎基底动脉串联闭塞（VBTO）标准治疗方法的作用尚未得到证实。我们的目标是评估与孤立性BAO（IBAO）相比，VBTO血管内治疗的技术可行性、安全性和功能结局。
我们回顾性分析了2016年9月至2021年11月期间来自六个三级中心的所有前瞻性收集的急性BAO患者。患者随后被分为两组：VBTO组和IBAO组。比较两组的基线数据、手术细节和结局。
共纳入190例患者，55例为VBTO，135例为IBAO。两组成功再通的情况同样常见（89.1%和86.0%）。与IBAO患者相比，VBTO患者获得良好功能结局（改良Rankin量表：0 - 2）的比例更高（36.4%对25.2%，p = 0.048），死亡率更低（29.1%对33.3%）。然而，在对混杂因素进行调整后，这些关联消失了（调整后的优势比[aOR]为0.86，95%置信区间为0.35 - 2.05；aOR为0.93，95%置信区间为0.35 - 2.45）。两组有症状性颅内出血的发生率没有差异（VBTO组：7.3%对IBAO组：4.2%；p = 0.496）。
VBTO的血管内治疗在技术上是可行且安全的，成功再通率、良好功能结局率和死亡率与IBAO患者相似。
