Žakelj Nina, Rigler Igor, Longo Alja, Frol Senta, Pretnar Oblak Janja
University Medical Centre Ljubljana, Ljubljana, Slovenia.
University Medical Centre Ljubljana, Ljubljana, Slovenia
J Neurointerv Surg. 2025 Jan 26. doi: 10.1136/jnis-2024-022065.
Despite its low incidence, basilar artery occlusion (BAO) remains a major therapeutic challenge since severe disability and death occur in about 80% of patients. Specific site of BAO (proximal, middle, or distal) has rarely been reported as a prognostic factor in reperfusion therapy. We aimed to explore the relationship between site-specific BAO and clinical outcomes in patients treated with reperfusion therapies.
We performed a single-centre retrospective study of all consecutive patients with acute BAO admitted to the University Medical Centre Ljubljana between January 2013 and August 2022 who were treated with reperfusion therapies. Patients were grouped according to the location of BAO and compared for baseline characteristics, differences in stroke aetiology, type of reperfusion therapy, success of recanalization, and clinical outcome after 90 days evaluated by the modified Rankin Scale (mRS) score. Statistical analysis was performed with the two-sided ANOVA t-tests for continuous measures, Chi-squared (χ2) tests for categorical measures and a multivariate ordinal logistic regression analysis.
The study included 103 patients (47% females, median age 74 years; confidence interval (CI) 72 to 98). Proximal BAO was found in 13%, middle in 13%, and distal in 74% of patients. Cardioembolic etiology was more common in distal (=0.01), and atherosclerotic etiology in proximal and middle BAO occlusions (P=0.02). While distal BAO was more likely to be recanalized using intravenous thrombolysis (IVT) compared with other sites of occlusion (P=0.05), we found no difference between different occlusion sites and the success of endovascular treatment (EVT). Lower age (odds ratio (OR) 0.89; CI 0.84 to 0.95; P<0.01) and shorter time to intervention (OR 0.71; CI 0.53 to 0.95; P=0.02), regardless of it being IVT or EVT, were predictors of an excellent clinical outcome (mRS 0-2). Distal occlusion (OR 28; CI 2.7 to 300; p<0.01) was a strong predictor of a favorable clinical outcome (mRS 0-3).
Prompt reperfusion, regardless of it being IVT or EVT, increases the chance of excellent clinical outcomes in patients with acute BAO. Distal BAO is more often associated with a favorable clinical outcome compared with the proximal and middle segments.
尽管基底动脉闭塞（BAO）的发病率较低，但由于约80%的患者会出现严重残疾和死亡，它仍然是一个重大的治疗挑战。BAO的具体部位（近端、中段或远端）作为再灌注治疗的预后因素鲜有报道。我们旨在探讨特定部位的BAO与接受再灌注治疗患者的临床结局之间的关系。
我们对2013年1月至2022年8月间在卢布尔雅那大学医学中心收治的所有连续急性BAO患者进行了单中心回顾性研究，这些患者均接受了再灌注治疗。根据BAO的部位对患者进行分组，并比较其基线特征、卒中病因差异、再灌注治疗类型、再通成功率以及90天后通过改良Rankin量表（mRS）评分评估的临床结局。对连续变量采用双侧方差分析t检验、分类变量采用卡方（χ2）检验进行统计分析，并进行多变量有序逻辑回归分析。
该研究纳入了103例患者（47%为女性，中位年龄74岁；置信区间（CI）为72至98）。13%的患者为近端BAO，13%为中段，74%为远端。心源性栓塞病因在远端更为常见（P=0.01），而近端和中段BAO闭塞的动脉粥样硬化病因更为常见（P=0.02）。与其他闭塞部位相比，远端BAO使用静脉溶栓（IVT）更有可能实现再通（P=0.05），但我们发现不同闭塞部位与血管内治疗（EVT）的成功率之间没有差异。年龄较低（优势比（OR）0.89；CI 0.84至0.95；P<0.01）和干预时间较短（OR 0.71；CI 0.53至0.95；P=0.02），无论采用IVT还是EVT，都是良好临床结局（mRS 0-2）的预测因素。远端闭塞（OR 28；CI 2.7至300；P<0.01）是良好临床结局（mRS 0-3）的有力预测因素。
无论采用IVT还是EVT，及时再灌注均可增加急性BAO患者获得良好临床结局的机会。与近端和中段相比，远端BAO更常与良好的临床结局相关。
