串联病变是急性基底动脉闭塞血管内治疗预后不良的危险因素：单中心队列研究

doi:10.3969/j.issn.1672-6731.2020.05.005

摘要/Abstract

摘要：

目的探讨串联病变对急性基底动脉闭塞患者血管内治疗预后的预测价值。方法纳入2012年1月至2018年7月共187例急性基底动脉闭塞患者（包括串联病变25例、非串联病变162例），均行血管内治疗，术前采用后循环Alberta脑卒中计划早期CT评分（pc-ASPECTS）和脑桥-中脑指数（PMI）评价脑梗死范围，后交通评分和美国介入和治疗性神经放射学学会/美国介入放射学学会（ASITN/SIR）分级评价基底动脉闭塞后后循环侧支代偿。主要预后指标为术后即刻血管再通率以及治疗后90 d功能独立性和预后，主要安全终点为术后7 d内颅内出血和症状性颅内出血发生率以及治疗后90 d病死率。结果串联病变组患者病变主要位于基底动脉起始部（包括椎动脉颅内段）和远端（P=0.000）、合并颅内动脉狭窄比例较低（P=0.000）。25例串联病变患者中21例采取Dirty-road路径、4例采取Clean-road路径，支架取栓（P=0.030）和术中静脉注射替罗非班（P=0.028）比例更低，支架植入比例更高（P=0.005），术后即刻血管再通率更低（P=0.001），治疗后90 d病死率更高（P=0.002）。单因素和多因素Logistic回归分析显示，串联病变是急性基底动脉闭塞术后即刻血管再通率较低（OR=0.050，95% CI：0.010~0.530；P=0.012）和治疗后90 d病死率较高（OR=17.320，95% CI：2.700~111.040；P=0.003）的危险因素。结论串联病变是急性基底动脉闭塞患者血管内治疗后预后不良的危险因素。

关键词: 椎底动脉供血不足, 动脉闭塞性疾病, 支架, 预后, 危险因素, Logistic 模型, 脑血管造影术

Abstract:

Objective To evaluate whether patients with acute basilar artery occlusion (BAO) tandem lesion could affect the clinical outcome after receiving endovascular treatment (EVT) in a high-volume stroke center. Methods A total of 187 consecutive patients with acute BAO receiving EVT from January 2012 to July 2018 were recruited in this study. The patients were categorized into 2 groups with (25 cases) or without (162 cases) tandem lesion. Preoperative Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrairn Index (PMI) were used to evaluate the cerebral infarction range, and Post-Traffic Score and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading were used to evaluate the posterior circulation collateral compensation after actue BAO. The main prognostic indicators were immediate postoperative vascular recanalization rate, functional independence and prognosis 90 d after treatment, and the main safety endpoints were intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH) incidence 7 d after surgery and mortality 90 d after treatment. Results In tandem group, the lesions were mainly located at the beginning of the basilar artery (including the intracranial segment of the vertebral artery) and at the distal end (P=0.000), and the proportion of intracranial arterial stenosis was lower (P=0.000). Among the 25 patients with tandem lesion, 21 took the Dirty-road route and 4 took the Clean-road route. The proportion of stent thrombectomy (P=0.030) and intraoperative intravenous injection of tirofibana (P=0.028) was lower, the proportion of stent implantation was higher (P=0.005), the proportion of vascular recanalization after treatment was lower (P=0.001), and the mortality rate was higher 90 d after treatment (P=0.002). Univariate and multivariate Logistic regression analysis showed that acute BAO tandem lesion had a lower immediate vascular recanalization rate (OR=0.050, 95% CI:0.010-0.530; P=0.012) and a higher mortality 90 d after treatment (OR=17.320, 95% CI:2.700-111.040; P=0.003). Conclusions Tandem lesion seems to be associated with low rate of recanalization and high rate of mortality in patients with acute BAO.

Key words: Vertebrobasilar insufficiency, Arterial occlusive diseases, Stents, Prognosis, Risk factors, Logistic models, Cerebral angiography

孙瑄, 高峰, 佟旭, 邓一鸣, 马宁, 莫大鹏, 宋立刚, 刘恋, 霍晓川, 徐晓彤, 缪中荣. 串联病变是急性基底动脉闭塞血管内治疗预后不良的危险因素：单中心队列研究[J]. 中国现代神经疾病杂志, 2020, 20(5): 392-398.

SUN Xuan, GAO Feng, TONG Xu, DENG Yi-ming, MA Ning, MO Da-peng, SONG Li-gang, LIU Lian, HUO Xiao-chuan, XU Xiao-tong, MIAO Zhong-rong. Tandem lesion was risk factor for endovascular treatment in acute basilar artery occlusion: a single center retrospective observational study[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 392-398.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I5/392

参考文献

[1] Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, Engelter ST, Tanne D, Muir KW, Molina CA, Thijs V, Audebert H, Pfefferkorn T, Szabo K, Lindsberg PJ, de Freitas G, Kappelle LJ, Algra A; BASICS Study Group. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS):a prospective registry study[J]. Lancet Neurol, 2009, 8:724-730.
[2] Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ. Outcome in patients with basilar artery occlusion treated conventionally[J]. J Neurol Neurosurg Psychiatry, 2005, 76:1238-1241.
[3] Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES Collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J]. Lancet, 2016, 387:1723-1731.
[4] Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, Guillemin F; THRACE Investigators. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE):a randomised controlled trial[J]. Lancet Neurol, 2016, 15:1138-1147.
[5] Glass TA, Hennessey PM, Pazdera L, Chang HM, Wityk RJ, Dewitt LD, Pessin MS, Caplan LR. Outcome at 30 days in the New England Medical Center Posterior Circulation Registry[J]. Arch Neurol, 2002, 59:369-376.
[6] De Marchis GM, Kohler A, Renz N, Arnold M, Mono ML, Jung S, Fischer U, Karameshev AI, Brekenfeld C, Gralla J, Schroth G, Mattle HP, Nedeltchev K. Posterior versus anterior circulation strokes:comparison of clinical, radiological and outcome characteristics[J]. J Neurol Neurosurg Psychiatry, 2011, 82:33-37.
[7] Ecker RD, Tsujiura CA, Baker CB, Cushing D. Endovascular reconstruction of vertebral artery occlusion prior to basilar thrombectomy in a series of six patients presenting with acute symptomatic basilar thrombosis[J]. J Neurointerv Surg, 2014, 6:379-383.
[8] Hacke W, Zeumer H, Ferbert A, Brückmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease[J]. Stroke, 1988, 19:1216-1222.
[9] Brandt T, von Kummer R, Müller-Küppers M, Hacke W. Thrombolytic therapy of acute basilar artery occlusion:variables affecting recanalization and outcome[J]. Stroke, 1996, 27:875-881.
[10] Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Classification of subtype of acute ischemic stroke:definitions for use in a multicenter clinical trial. TOAST:Trial of Org 10172 in Acute Stroke Treatment[J]. Stroke, 1993, 24:35-41.
[11] Yoon W, Kim SK, Heo TW, Baek BH, Lee YY, Kang HK. Predictors of good outcome after stent-retriever thrombectomy in acute basilar artery occlusion[J]. Stroke, 2015, 46:2972-2975.
[12] Pallesen LP, Khomenko A, Dzialowski I, Barlinn J, Barlinn K, Zerna C, van der Hoeven EJ, Algra A, Kapelle LJ, Michel P, Bodechtel U, Demchuk AM, Schonewille W, Puetz V; BASICS-Study Group. CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study[J]. Int J Stroke, 2017, 12:145-151.
[13] Goyal N, Tsivgoulis G, Nickele C, Doss VT, Hoit D, Alexandrov AV, Arthur A, Elijovich L. Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion[J]. J Neurointerv Surg, 2016, 8:783-786.
[14] Singer OC, Berkefeld J, Nolte CH, Bohner G, Haring HP, Trenkler J, Grö schel K, Müller-Forell W, Niederkorn K, Deutschmann H, Neumann-Haefelin T, Hohmann C, Bussmeyer M, Mpotsaris A, Stoll A, Bormann A, Brenck J, Schlamann MU, Jander S, Turowski B, Petzold GC, Urbach H, Liebeskind DS; ENDOSTROKE Study Group. Mechanical recanalization in basilar artery occlusion:the ENDOSTROKE study[J]. Ann Neurol, 2015, 77:415-424.
[15] Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49:E46-110.
[16] Cohen JE, Leker RR, Gomori JM, Eichel R, Rajz G, Moscovici S, Itshayek E. Emergent revascularization of acute tandem vertebrobasilar occlusions:endovascular approaches and technical considerations-confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke[J]. J Clin Neurosci, 2016, 34:70-76.
[17] Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, Marks MP, Prabhakaran S, Kallmes DF, Fitzsimmons BF, Mocco J, Wardlaw JM, Barnwell SL, Jovin TG, Linfante I, Siddiqui AH, Alexander MJ, Hirsch JA, Wintermark M, Albers G, Woo HH, Heck DV, Lev M, Aviv R, Hacke W, Warach S, Broderick J, Derdeyn CP, Furlan A, Nogueira RG, Yavagal DR, Goyal M, Demchuk AM, Bendszus M, Liebeskind DS; Cerebral Angiographic Revascularization Grading (CARG) Collaborators, STIR Revascularization Working Group, STIR Thrombolysis in Cerebral Infarction (TICI) Task Force. Recommendations on angiographic revascularization grading standards for acute ischemic stroke:a consensus statement[J]. Stroke, 2013, 44:2650-2663.
[18] Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J]. N Engl J Med, 2008, 359:1317-1329.
[19] Savitz SI, Caplan LR. Vertebrobasilar disease[J]. N Engl J Med, 2005, 352:2618-2626.
[20] Ecker RD, Tsujiura CA, Baker CB, Cushing D. Endovascular reconstruction of vertebral artery occlusion prior to basilar thrombectomy in a series of six patients presenting with acute symptomatic basilar thrombosis[J]. J Neurointerv Surg, 2014, 6:379-383.
[21] Yang H, Ma N, Zhang S, Huo X, Gao F, Sun X, Mo D, Miao Z. Endovascular revascularisation of acute tandem vertebrobasilar artery occlusion:seven case series with literature reviews[J]. Stroke Vasc Neurol, 2018, 3:17-21.
[22] Changa JY, Junga S, Jungc C, Bae HJ, Kwon O, Han MK. Dominant vertebral artery status and functional outcome after endovascular therapy of symptomatic basilar artery occlusion[J]. J Neuroradiol, 2017, 44:151-157.
[23] Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS. New England Medical Center posterior circulation registry[J]. Ann Neurol, 2004, 56:389-398.
[24] Caplan LR, Amarenco P, Rosengart A, Lafranchise EF, Teal PA, Belkin M, DeWitt LD, Pessin MS. Embolism from vertebral artery origin occlusive disease[J]. Neurology, 1992, 42:1505-1512.
[25] Al-Ali F, Barrow T, Duan L, Jefferson A, Louis S, Luke K, Major K, Smoker S, Walker S, Yacobozzi M. Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke:result from borgess medical center vertebral artery ostium stenting registry[J]. Stroke, 2011, 42:2544-2549.
[26] Puri AS, Kühn AL, Kwon HJ, Khan M, Hou SY, Lin E, Chueh J, van der Bom IM, Dabus G, Linfante I, Gounis MJ, Wakhloo AK. Endovascular treatment of tandem vascular occlusions in acute ischemic stroke[J]. J NeuroIntervent Surg, 2014, 7:158-163.

选择文件类型/文献管理软件名称

选择包含的内容

2 串联病变是急性基底动脉闭塞血管内治疗预后不良的危险因素：单中心队列研究

Tandem lesion was risk factor for endovascular treatment in acute basilar artery occlusion: a single center retrospective observational study

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	刘俊其, 王蠡, 王振霖, 张秋航, 齐岩, 危维. 内镜下经口鼻联合入路手术切除颅底脊索瘤[J]. 中国现代神经疾病杂志, 2023, 23(7): 580-585.
[2]	冯珊珊. 基于危险因素的库欣病患者视力视野客观检查卫生经济学分析[J]. 中国现代神经疾病杂志, 2023, 23(7): 613-620.
[3]	邹婷婷, 马莉, 潘文静, 李长秀, 胡乃霞, 王擂. 重型颅脑创伤并发颅内感染危险因素分析及列线图预测模型构建[J]. 中国现代神经疾病杂志, 2023, 23(6): 496-502.
[4]	张磊, 张涛. 脑电双频指数与自发性脑出血患者预后相关性分析[J]. 中国现代神经疾病杂志, 2023, 23(6): 515-521.
[5]	刘臣超, 刘慧权, 袁小勇, 王健, 陈绅, 王义义, 柳兴军. 重症结核性脑膜炎预后不良影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(6): 522-529.
[6]	曾高, 刘雨桐, 孙澎, 杜建新. 儿童脑动静脉畸形治疗策略[J]. 中国现代神经疾病杂志, 2023, 23(5): 388-392.
[7]	郭中印, 彭鹏, 陈籽荣, 张晓琳, 董民海, 曾括, 万丽君, 向网, 万锋. 幕上肿瘤患儿手术后行脑室-腹腔分流术危险因素分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 412-417.
[8]	彭小娇, 葛明, 吴迪, 蔡英杰, 陈佳树, 梁琛. 单中心儿童颅咽管瘤手术后下丘脑性肥胖危险因素分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 418-424.
[9]	韩国庆, 蒲珂, 黄志发, 尚彦国, 李庆国. 儿童脑动静脉畸形治疗方式及预后分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 425-432.
[10]	冯增伟, 丁平, 廖先文, 焦永辉, 左云龙, 韩宏彦. 烟雾病脑血管重建术后发生脑过度灌注综合征的临床分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 460-466.
[11]	余彩遥, 叶兰, 冯占辉. 癫痫患者认知功能障碍相关危险因素研究进展[J]. 中国现代神经疾病杂志, 2023, 23(4): 287-291.
[12]	孙艳, 范茹雪, 陈慧丰, 尹洁, 张楠. 天津市部分城市社区老年人群轻度认知损害患病情况及影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 303-309.
[13]	乔雨晨, 常红, 王佳妹, 杨璇, 魏娜, 丁爱聪. 认知功能障碍患者激越行为特点及影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 310-316.
[14]	甘景环, 陈志超, 刘帅, 吴昊, 纪勇. 血浆促食欲素A与路易体痴呆核心临床症状相关性分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 317-325.
[15]	廖先文, 丁平, 焦永辉, 冯增伟, 于俪苹, 韩宏彦. 新型联合血管重建术对成人烟雾病患者认知功能的影响[J]. 中国现代神经疾病杂志, 2023, 23(4): 359-367.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 串联病变是急性基底动脉闭塞血管内治疗预后不良的危险因素：单中心队列研究

Tandem lesion was risk factor for endovascular treatment in acute basilar artery occlusion: a single center retrospective observational study

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价