Cross D T, Moran C J, Akins P T, Angtuaco E E, Derdeyn C P, Diringer M N
Department of Radiology, Washington University School of Medicine, St Louis, MO, USA.
AJNR Am J Neuroradiol. 1998 Sep;19(8):1557-63.
This study was undertaken to examine the relationship between collateral flow and outcome after local intraarterial thrombolytic treatment for basilar artery thrombosis.
Twenty-four patients with symptomatic basilar thrombosis were treated with intraarterial urokinase. Angiograms at the time of treatment were analyzed to characterize collateral flow. The number of posterior communicating arteries (PCoAs) and the degree of collateral filling of the basilar artery were then compared with symptom duration before treatment, with Glasgow Coma Scale (GCS) score at the time of treatment, with 90-day modified Rankin score, and with 90-day survival status.
Of the 20 patients who had carotid artery injections at the time of the thrombolytic procedure, two had no PCoA, eight had one PCoA, and 10 had two PCoAs. Nine had no collateral opacification of the basilar artery, six had collateral opacification of the distal basilar artery, and five had collateral opacification of the distal and proximal basilar artery. Ninety-day survival was 38%; 25% of patients had good neurologic outcomes. No correlation was found between the number of PCoAs and symptom duration, pretreatment GCS score, survival, or neurologic outcome. Duration of symptoms before treatment was longer in patients with collateral flow to the basilar artery. Basilar artery collateral flow did not correlate with survival, but it did correlate with neurologic outcome for the 12 patients with middle or distal basilar artery thrombus in whom collateral flow to the basilar artery was assessed (83% with collateral flow had good neurologic outcomes, but only 17% without collateral flow had good outcomes). All six patients with proximal basilar artery thrombus in whom collateral flow was assessed died, independent of the collateral flow observed.
In symptomatic acute basilar artery thrombosis, neurologic outcome was better after intraarterial thrombolysis in patients who had collateral filling of the basilar artery, except in cases of proximal basilar thrombosis. Patients with collateral filling of the basilar artery also tolerated longer symptom duration.
本研究旨在探讨基底动脉血栓形成局部动脉内溶栓治疗后侧支血流与预后之间的关系。
对24例有症状的基底动脉血栓形成患者进行动脉内尿激酶治疗。分析治疗时的血管造影片以确定侧支血流情况。然后将后交通动脉（PCoA）的数量以及基底动脉的侧支充盈程度与治疗前的症状持续时间、治疗时的格拉斯哥昏迷量表（GCS）评分、90天改良Rankin评分以及90天生存状态进行比较。
在溶栓过程中接受颈动脉注射的20例患者中，2例无PCoA，8例有1条PCoA，10例有2条PCoA。9例基底动脉无侧支显影，6例基底动脉远端有侧支显影，5例基底动脉远端和近端均有侧支显影。90天生存率为38%；25%的患者有良好的神经功能预后。未发现PCoA的数量与症状持续时间、治疗前GCS评分、生存率或神经功能预后之间存在相关性。基底动脉有侧支血流的患者治疗前症状持续时间较长。基底动脉侧支血流与生存率无关，但对于12例评估了基底动脉侧支血流的基底动脉中、远端血栓形成患者，侧支血流与神经功能预后相关（有侧支血流的患者中83%有良好的神经功能预后，而无侧支血流的患者中只有17%有良好预后）。所有6例评估了侧支血流的基底动脉近端血栓形成患者均死亡，与观察到的侧支血流情况无关。
在有症状的急性基底动脉血栓形成中，除基底动脉近端血栓形成外，基底动脉有侧支充盈的患者动脉内溶栓后神经功能预后较好。基底动脉有侧支充盈的患者也能耐受较长的症状持续时间。
