Wang Zekun, Ji Kangxiang, Fang Qi
Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China.
Neuropsychiatr Dis Treat. 2024 May 16;20:1065-1077. doi: 10.2147/NDT.S458467. eCollection 2024.
Futile recanalization (FR) remains a significant challenge in patients with acute basilar artery occlusion (BAO) following successful endovascular treatment (EVT). This study aimed to investigate the predictive value of computed tomography perfusion (CTP)-based software (AutoMIStar; Apollo) for FR among BAO patients undergoing EVT.
We analyzed a prospectively maintained database to identify consecutive BAO patients who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction grade ≥ 2b) after EVT between January 2020 and September 2022. Clinical characteristics and imaging parameters from non-contrast CT, CT angiography, and CTP-AutoMIStar were collected for analysis. FR was defined as an unfavorable outcome (modified Rankin Scale score > 3) at 90 days despite successful recanalization. Multivariable stepwise logistic regression analysis was performed to identify independent predictors of FR.
Of the 54 patients included in this study, 24 (44.4%) experienced FR. In the univariate analysis, admission National Institutes of Health Stroke Scale score, posterior circulation Acute Stroke Prognosis Early CT Score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, hypoperfusion intensity ratio, and perfusion deficit volume in delay time (DT) > 4 s, DT > 6 s, DT > 8 s, and all cerebral blood flow (CBF) thresholds were associated with FR (all < 0.05). In the multivariate analysis, perfusion deficit volume in CBF < 35% (adjusted odds ratio [aOR] = 1.105, 95% confidence interval [CI]: 1.004-1.215; = 0.040) and BATMAN score (aOR = 0.662, 95% CI: 0.455-0.964; = 0.031) remained independent predictors of FR.
Perfusion deficit volume in CBF < 35% on CTP-AutoMIStar imaging maps and BATMAN score are independent predictors of FR after EVT in BAO patients. There is a significant positive correlation between perfusion deficit volume in CBF < 35% and the occurrence of FR.
在急性基底动脉闭塞（BAO）患者成功进行血管内治疗（EVT）后，无效再通（FR）仍然是一个重大挑战。本研究旨在探讨基于计算机断层扫描灌注（CTP）的软件（AutoMIStar；Apollo）对接受EVT的BAO患者FR的预测价值。
我们分析了一个前瞻性维护的数据库，以确定2020年1月至2022年9月期间在EVT后实现成功再通（改良脑梗死溶栓分级≥2b）的连续BAO患者。收集非增强CT、CT血管造影和CTP-AutoMIStar的临床特征和影像参数进行分析。FR被定义为尽管成功再通，但90天时预后不良（改良Rankin量表评分>3）。进行多变量逐步逻辑回归分析以确定FR的独立预测因素。
本研究纳入的54例患者中，24例（44.4%）出现FR。在单变量分析中，入院时美国国立卫生研究院卒中量表评分、后循环急性卒中预后早期CT评分、CT血管造影上的基底动脉（BATMAN）评分、低灌注强度比以及延迟时间（DT）>4 s、DT>6 s、DT>8 s时的灌注缺损体积和所有脑血流量（CBF）阈值均与FR相关（均<0.05）。在多变量分析中，CBF<35%时的灌注缺损体积（调整优势比[aOR]=1.105，95%置信区间[CI]：1.004-1.215；P=0.040）和BATMAN评分（aOR=0.662，95%CI：0.455-0.964；P=0.031）仍然是FR的独立预测因素。
CTP-AutoMIStar影像图上CBF<35%时的灌注缺损体积和BATMAN评分是BAO患者EVT后FR的独立预测因素。CBF<35%时的灌注缺损体积与FR的发生之间存在显著正相关。
