Cross D T, Moran C J, Akins P T, Angtuaco E E, Diringer M N
Department of Radiology, Washington University School of Medicine, St. Louis, Mo 63110, USA.
AJNR Am J Neuroradiol. 1997 Aug;18(7):1221-8.
To identify factors that predict survival and good neurologic outcome in patients undergoing basilar artery thrombolysis.
Over a 42-month period, 20 of 22 consecutive patients with angiographic proof of basilar artery thrombosis were treated with local intraarterial urokinase. Brain CT scans, neurologic examinations, symptom duration, clot location, and degree of recanalization were analyzed retrospectively.
Overall survival was 35% at 3 months. Survival in patients with only distal basilar clot was 71%, while survival in patients with proximal or midbasilar clot was only 15%. At 3 months, 29% of patients with distal basilar clot and 15% of patients with proximal or midbasilar clot had good neurologic outcomes (modified Rankin score of 0 to 2 and Barthel index of 95 to 100). Complete recanalization was achieved in 50% of patients; 60% of those survived and 30% had good neurologic outcomes. Of patients with less than complete recanalization, only 10% survived. Neither duration of symptoms before treatment (range, 1 to 79 hours), age (range, 12 to 83 years), nor neurologic status at the initiation of treatment (Glasgow Coma Scale score range, 3 to 15) predicted outcome. Pretreatment CT findings (positive or negative for related ischemic changes) did not predict outcome or hemorrhagic transformation.
The single best predictor of survival after basilar thrombosis and intraarterial thrombolysis was distal clot location. Complete recanalization favored survival. Radiologically evident related infarctions, advanced age, delayed diagnosis, and poor pretreatment neurologic status did not predict poor outcome and therefore should not be considered absolute contraindications for intraarterial thrombolysis in patients with basilar artery thrombosis.
确定能预测接受基底动脉溶栓治疗患者生存及良好神经功能转归的因素。
在42个月期间，对连续22例经血管造影证实为基底动脉血栓形成的患者中的20例进行了局部动脉内尿激酶治疗。对脑部CT扫描、神经学检查、症状持续时间、血栓位置及再通程度进行了回顾性分析。
3个月时总体生存率为35%。仅远端基底动脉血栓患者的生存率为71%，而近端或基底动脉中段血栓患者的生存率仅为15%。3个月时，远端基底动脉血栓患者中有29%、近端或基底动脉中段血栓患者中有15%神经功能转归良好（改良Rankin量表评分为0至2分，Barthel指数为95至100）。50%的患者实现了完全再通；其中60%存活且30%神经功能转归良好。再通不完全的患者中，仅10%存活。治疗前症状持续时间（范围为1至79小时）、年龄（范围为12至83岁）及治疗开始时的神经状态（格拉斯哥昏迷量表评分范围为3至15分）均不能预测转归。治疗前CT表现（相关缺血性改变为阳性或阴性）不能预测转归或出血性转化。
基底动脉血栓形成及动脉内溶栓后生存的最佳单一预测因素是远端血栓位置。完全再通有利于生存。放射学上明显的相关梗死、高龄、诊断延迟及治疗前神经状态不佳并不能预测不良转归，因此不应被视为基底动脉血栓形成患者动脉内溶栓的绝对禁忌证。
