Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Eur J Neurol. 2024 Sep;31(9):e16380. doi: 10.1111/ene.16380. Epub 2024 Jun 24.
This study aimed to investigate the effect of collateral circulation on the outcomes of thrombectomy versus medical management alone in basilar artery occlusion (BAO) patients with varying stroke severities.
Data from the ATTENTION cohort were used to perform a post-hoc analysis comparing the outcomes of thrombectomy with medical management in BAO patients with varying degrees of collateral circulation and stroke severity. Basilar Artery on Computed Tomography Angiography (BATMAN) scores were used to quantify the collateral circulation, and the effect was estimated through a primary outcome of 90-day functional independence (modified Rankin Scale score, mRS ≤2). Favorable versus unfavorable BATMAN scores were analyzed as both continuous and categorical variables, and an adjusted multivariate regression model was applied.
Among 221 BAO patients, thrombectomy significantly improved functional independence compared to medical management in patients with favorable BATMAN scores (aOR 7.75, 95% CI 2.78-26.1), but not in those with unfavorable BATMAN scores (aOR 1.33, 95% CI 0.28-6.92; p = 0.028). When treated as a continuous variable, increased BATMAN score was found to be associated with a higher likelihood of functional independence in the thrombectomy group (aOR 1.97, 95% CI 1.44-2.81; p = 0.053). In severe stroke patients with higher BATMAN scores (National Institutes of Health Stroke Scale (NIHSS) ≥21), we identified a significant interaction for treatment effect with thrombectomy compared to medical management (p = 0.042).
An increased BATMAN score was significantly associated with a higher probability of functional independence after thrombectomy than after medical management, particularly in patients with severe BAO.
本研究旨在探讨不同侧支循环状态和卒中严重程度的基底动脉闭塞（BAO）患者中，与单纯药物治疗相比，血管内取栓治疗的效果。
利用 ATTENTION 队列的数据进行一项回顾性分析，比较不同侧支循环和卒中严重程度的 BAO 患者中血管内取栓治疗与单纯药物治疗的结局。采用基底动脉计算机断层血管造影（BATMAN）评分来量化侧支循环，通过 90 天功能独立的主要结局（改良 Rankin 量表评分，mRS≤2）来估计疗效。将有利与不利的 BATMAN 评分作为连续和分类变量进行分析，并应用调整后的多变量回归模型。
在 221 例 BAO 患者中，与单纯药物治疗相比，在 BATMAN 评分有利的患者中，血管内取栓治疗显著改善了功能独立性（优势比 7.75，95%置信区间 2.78-26.1），但在 BATMAN 评分不利的患者中则没有（优势比 1.33，95%置信区间 0.28-6.92；p=0.028）。当作为连续变量处理时，发现 BATMAN 评分升高与血管内取栓组功能独立性更高相关（优势比 1.97，95%置信区间 1.44-2.81；p=0.053）。在 BATMAN 评分较高（美国国立卫生研究院卒中量表（NIHSS）≥21）的严重卒中患者中，我们发现血管内取栓治疗与单纯药物治疗的治疗效果存在显著的交互作用（p=0.042）。
与单纯药物治疗相比，增加的 BATMAN 评分与血管内取栓治疗后功能独立性更高显著相关，特别是在严重 BAO 患者中。
