Hashimoto Yukishige, Ikawa Fusao, Kawano Reo, Hidaka Toshikazu, Inoue Yusuke, Yamamoto Yusuke, Horie Nobutaka
Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan.
Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan.
J Clin Med. 2025 Sep 10;14(18):6384. doi: 10.3390/jcm14186384.
: The accurate evaluation of stroke etiology in basilar artery occlusion (BAO) remains underexplored. This study aimed to explore a simple and practical method for predicting the in situ atherosclerotic thrombosis (ISAT) subtype of BAO. We retrospectively analyzed patients diagnosed with BAO at our institution between April 2015 and April 2025. ISAT was characterized by moderate-to-severe stenosis (>50%) at the occlusion site on angiography, while the cardioembolism (CE) subtype was defined as sudden-onset arterial occlusion with evidence of a cardiac source of embolism. The location of BAO was classified based on cerebral angiography findings as proximal, middle, or distal. Clinical and imaging characteristics were compared between CE and ISAT subtypes. Among 33 patients, 8 (24%) were classified as having the ISAT subtype. Multivariable analyses revealed that the presence of atrial fibrillation (AF) (OR 0.03; 95% CI, 0.00-0.56) and a non-proximal occlusion site (i.e., middle or distal) (OR 0.02; 95% CI, 0.00-0.27) were independently associated with ISAT. Patients were stratified into four groups based on the presence or absence of proximal occlusion and AF. CE subtypes predominated in groups with either AF or no proximal occlusion (25/27, 93%), whereas ISAT was present in all patients with both proximal occlusion and absence of AF (6/6, 100%). The area under the curve for this classification was 0.955. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing ISAT were 75%, 100%, 100%, and 93%, respectively. A simple classification based on the presence of proximal occlusion and AF status suggested the potential to facilitate preprocedural differentiation of ISAT subtype in BAO.
基底动脉闭塞（BAO）中风病因的准确评估仍未得到充分探索。本研究旨在探索一种简单实用的方法来预测BAO的原位动脉粥样硬化血栓形成（ISAT）亚型。我们回顾性分析了2015年4月至2025年4月在我院诊断为BAO的患者。ISAT的特征是血管造影显示闭塞部位有中度至重度狭窄（>50%），而心源性栓塞（CE）亚型定义为突然发生的动脉闭塞且有心脏栓塞源的证据。根据脑血管造影结果将BAO的位置分为近端、中段或远端。比较了CE和ISAT亚型之间的临床和影像学特征。在33例患者中，8例（24%）被分类为ISAT亚型。多变量分析显示，心房颤动（AF）的存在（OR 0.03；95%CI，0.00-0.56）和非近端闭塞部位（即中段或远端）（OR 0.02；95%CI，0.00-0.27）与ISAT独立相关。根据近端闭塞和AF的有无将患者分为四组。AF组或无近端闭塞组中CE亚型占主导（25/27，93%），而所有近端闭塞且无AF的患者均为ISAT（6/6，100%）。该分类的曲线下面积为0.955。诊断ISAT的敏感性、特异性、阳性预测值和阴性预测值分别为75%、100%、100%和93%。基于近端闭塞的存在和AF状态的简单分类表明，有可能促进BAO中ISAT亚型的术前鉴别。
