Adwane Grace, Lansberg Maarten G, Liebart Simon, Charbonneau Frederique, Schwartz Maya A, Heit Jeremy J, Mlynash Michael, Sablot Denis, Wacongne Anne, Desilles Jean-Philippe, Costalat Vincent, Obadia Michael, Henry Carole, Manchon Eric, Arquizan Caroline, Albers Gregory W, Ter Schiphorst Adrien, Seners Pierre
Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France.
Stanford Stroke Center, Palo Alto, CA, USA.
Int J Stroke. 2025 Jul 1:17474930251357739. doi: 10.1177/17474930251357739.
Patients with acute ischemic stroke and a large vessel occlusion admitted to non-endovascular capable centers frequently require inter-hospital transfer to a comprehensive stroke center (CSC) for thrombectomy. Data regarding arterial recanalization of patients with basilar artery occlusion (BAO) during transfer are lacking.
We analyzed prospectively collected data of acute stroke patients with BAO transferred for consideration of thrombectomy to three CSCs (Rothschild Hospital, France; Montpellier Hospital, France; Stanford Hospital, USA) between 2016 and 2024, with arterial imaging at the referring hospital and on CSC arrival. Inter-hospital recanalization was assessed by comparison of the baseline and post-transfer arterial imaging and was defined as 2a-3 on the modified Thrombolysis In Cerebral Infarction (mTICI) scale. Independent predictors of inter-hospital recanalization were assessed using multivariable logistic regression analysis.
Overall, 228 patients were included: median age 71 years, the National Institutes of Health Stroke Scale (NIHSS) of 14, transfer time of 3.5 h, and 39% of patients received intravenous thrombolysis (IVT) before transfer. The primary reason for withholding IVT was late presentation. Inter-hospital BAO recanalization occurred in 15% of patients. Variables independently associated with inter-hospital BAO recanalization were IVT use (adjusted odds ratio (aOR) = 24.3, 95% confidence interval (CI) = 6.9-85.5, < 0.01), distal BAO site (aOR = 2.9, 1.0-8.5, = 0.05), lack of diabetes (aOR = 11.4, 1.4-93.2, = 0.02), and non-atheromatous etiology (aOR = 6.6, 1.4-31.4, = 0.02). BAO recanalization rates ranged from 1% in non-IVT-treated patients with proximal BAO to 45% in IVT-treated patients with distal BAO. Inter-hospital recanalization was associated with an increased odds of good functional outcome (odds ratio (OR) for 3-month modified Rankin Scale (mRS) = 0-2 = 3.3, 95% CI = 1.2-8.8, = 0.02, adjusted for age, pre-stroke mRS, baseline NIHSS, Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), IVT use, and onset-to-imaging time).
BAO recanalization during inter-hospital transfer for thrombectomy occurred in 15% of patients and was associated with a favorable 3-month outcome. IVT use in the referring center was the primary modifiable factor associated with recanalization, yet its use remains low. Expanding IVT indications in primary stroke centers and developing new therapies that increase recanalization may improve outcomes.
入住无血管内治疗能力中心的急性缺血性卒中合并大血管闭塞患者通常需要转院至综合卒中中心（CSC）进行血栓切除术。目前缺乏关于基底动脉闭塞（BAO）患者在转院期间动脉再通的数据。
我们分析了2016年至2024年间前瞻性收集的因考虑进行血栓切除术而转至三家CSC（法国罗斯柴尔德医院；法国蒙彼利埃医院；美国斯坦福医院）的急性BAO卒中患者的数据，在转诊医院和到达CSC时均进行了动脉成像。通过比较基线和转院后的动脉成像评估院间再通情况，并根据改良脑梗死溶栓（mTICI）量表定义为2a-3级。使用多变量逻辑回归分析评估院间再通的独立预测因素。
总体纳入228例患者：中位年龄71岁，美国国立卫生研究院卒中量表（NIHSS）评分为14分，转院时间为3.5小时，39%的患者在转院前行静脉溶栓（IVT）治疗。未进行IVT治疗的主要原因是就诊延迟。15%的患者实现了院间BAO再通。与院间BAO再通独立相关的变量包括IVT治疗的使用（调整优势比（aOR）=24.3，95%置信区间（CI）=6.9-85.5，P<0.01）、BAO远端部位（aOR=2.9，1.0-8.5，P=0.05）、无糖尿病（aOR=11.4，1.4-93.2，P=0.02）和非动脉粥样硬化病因（aOR=6.6，1.4-31.4，P=0.02）。BAO再通率范围从近端BAO未接受IVT治疗患者的1%到远端BAO接受IVT治疗患者的45%。院间再通与良好功能预后的几率增加相关（3个月改良Rankin量表（mRS）评分为0-2分的优势比（OR）=3.3，95%CI=1.2-8.8，P=0.02，校正了年龄、卒中前mRS、基线NIHSS、后循环艾伯塔卒中项目早期计算机断层扫描评分（pc-ASPECTS）、IVT治疗的使用以及发病至成像时间）。
15%的患者在院间转至血栓切除术治疗期间实现了BAO再通，且与3个月的良好预后相关。在转诊中心使用IVT治疗是与再通相关的主要可改变因素，但其使用率仍然较低。扩大初级卒中中心的IVT治疗适应症并开发增加再通的新疗法可能会改善预后。
