摘要
目的分析急性椎基底动脉串联闭塞(acute tandem vertebrobasilar artery occlusion,VBO)的患者接受血管内治疗术(endovascular treatment,EVT)后的预后及其危险因素。方法采用2014年1月至2019年5月急性基底动脉闭塞血管内治疗的全国多中心临床登记研究(the EVT for Acute Basilar Artery Occlusion Study,BASILAR)的患者数据。所有患者接受了血管内治疗,并进行了为期90 d的随访。依据是否存在椎动脉及基底动脉串联病变将患者分为两组:椎基底动脉串联闭塞组(acute tandem vertebrobasilar artery occlusion,VBO)、单纯基底动脉闭塞组(acute basilar artery occlusion,BAO)。分析患者基线指标,并探讨两组患者的预后差异及其相关影响因素。结果共纳入647例符合条件的患者,中位年龄为64(56,74)岁,男性483例(74.7%)。有560例患者为单纯基底动脉闭塞;87例患者为基底动脉闭塞合并有椎动脉重度狭窄或闭塞。VBO组与BAO组的90 d良好预后率(定义为mRS评分0~3)(P=0.090)及死亡率(P=0.890)无明显差异。对于VBO组患者,更低的NIHSS评分[OR(95%CI):0.898(0.845~0.954),P<0.001]、更高的pc-ASPECTS评分[OR(95%CI):1.690(1.117~2.557),P=0.010]、更短的穿刺至再通时间[OR(95%CI):0.990(0.980~1.000),P=0.047]是影响患者90 d良好预后率的独立危险因素。同样的,更高的NIHSS评分[OR(95%CI):1.094(1.033~1.159),P=0.002]、更低的pc-ASPECTS评分[OR(95%CI):0.622(0.438~0.882),P=0.008]、更长的穿刺至再通时间[OR(95%CI):1.010(1.001~1.019),P=0.040]也是患者90 d死亡率预测因素。结论血管内治疗对于急性椎基底动脉串联闭塞安全有效,短期预后良好。NIHSS评分、pc-ASPECTS评分及穿刺至再通时间是VBO患者90 d良好预后的独立预测因素,也是其90 d死亡率预测因素。
Objective To analyze the prognosis and risk factors of acute tandem vertebrobasilar artery occlusion(VBO)after endovascular therapy(EVT).Methods This study used the patient data from the EVT for Acute Basilar Artery Occlusion Study(BASILAR),a national multicenter clinical registry study for endovascular treatment of acute basilar artery occlusion from January 2014 to May 2019.All patients received intravascular treatment and underwent a 90 d follow-up.According to the presence of vertebral artery and basilar artery occlusion,they were divided into vertebral basilar artery occlusion(VBO)group and acute basilar artery occlusion(BAO)group.Their baseline indicators were analyzed to explore the differences in prognosis and influencing factors between the 2 groups.Results A total of 647 eligible patients were included in this study,with a median age of 64(56,74)years,and 74.7%of them(483)were males.Among them,560 patients had simple basilar artery occlusion and the other 87 had basilar artery occlusion combined with severe stenosis or occlusion of the vertebral artery.There were no significant differences in the 90-day good prognosis rate(defined as mRS score of 0~3)(P=0.090)and mortality rate(P=0.890)between the VBO group and the BAO group.For the patients in the VBO group,lower NIHSS score(OR=0.898,95%CI:0.845~0.954,P<0.001),higher pc-ASPECTS score(OR=1.690,95%CI:1.117~2.557,P=0.010),and shorter puncture to recanalization time(OR=0.990,95%CI:0.980~1.000,P=0.047)were independent risk factors for 90-day good prognosis.Similarly,higher NIHSS score(OR=1.094,95%CI:1.033~1.159,P=0.002),lower pc-ASPECTS score(OR=0.622,95%CI:0.438~0.882,P=0.008)and longer puncture to recanalization time(OR=1.010,95%CI:1.001~1.019,P=0.040)were also predictive factors for 90-day mortality in these patients.Conclusion EVT is safe and effective for acute VBO,with a good short-term prognosis.NIHSS score,pc-ASPECTS score,and puncture to recanalization time are independent predictors for 90-day good prognosis in VBO patients,and are also predictors
作者
高攀
李凤利
资文杰
杨清武
GAO Pan;LI Fengli;ZI Wenjie;YANG Qingwu(Department of Neurology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2023年第18期1965-1973,共9页
Journal of Army Medical University
基金
国家杰出青年科学基金(81525008)。
关键词
血管内治疗
基底动脉
串联闭塞
良好预后
死亡率
endovascular therapy
basilar artery
tandem occlusion
good prognosis
mortality
