摘要：

目的: 筛查急性基底动脉闭塞血管内治疗（ABAO-EVT）的预后影响因素。方法: 回顾收集2017年10月至2022年8月中国科学技术大学附属第一医院、山东省临沂市人民医院和广东省茂名市人民医院共215例ABAO-EVT患者的基线、临床及随访资料：性别、年龄、脑卒中或短暂性脑缺血发作、高血压、糖尿病、冠心病、房颤、吸烟、饮酒、基线美国国立卫生研究院卒中量表（NIHSS）评分、静脉溶栓、首通效应、取栓次数、扩展脑梗死溶栓血流分级（eTICI）、术后90 d改良Rankin量表（mRS）评分。根据术后90 d mRS评分分为预后良好组（0~3分，93例）和预后不良组（4~6分，122例）。采用单因素和多因素逐步法Logistic回归分析筛查ABAO-EVT患者术后90 d神经功能预后影响因素。结果: Logistic回归分析显示：基线NIHSS评分增加是ABAO-EVT患者神经功能预后不良的危险因素（aOR=0.936，95% CI：0.907~0.965，P=0.000；aOR=0.940，95% CI：0.910~0.970，P=0.000），首通效应（aOR=5.752，95% CI：2.875~11.508；P=0.000）、eTICI分级2c~3级（aOR=7.113，95% CI：3.665~13.805；P=0.000）是神经功能预后良好的保护因素。结论: 较低的基线NIHSS评分、取得首通效应和达到eTICI分级2c~3级再灌注水平是ABAO-EVT患者神经功能预后良好的保护因素。

关键词: 缺血性卒中, 基底动脉, 血栓切除术, 预后, 再灌注, 危险因素, Logistic模型, 多中心研究

Abstract:

Objective: To screen the prognostic influencing factors of patients with endovascular treatment for acute basilar artery occlusion (ABAO-EVT). Methods: The baseline, clinical and follow-up data of 215 patients with ABAO-EVT from October 2017 to August 2022 in The First Affiliated Hospital of University of Science and Technology of China, Linyi People's Hospital of Shandong and Maoming People's Hospital of Guangdong were retrospectively collected, including sex, age, stroke or transient ischemic attack (TIA), hypertension, diabetes, coronary heart disease, atrial fibrillation, smoking and drinking history, National Institutes of Health Stroke Scale (NIHSS) score, intravenous thrombolysis, first pass effect, times of embolectomy, extended Thrombolysis in Cerebral Infarction (eTICI), and modified Rankin Scale (mRS) score 90 d after operation.According to the 90 d mRS score, the patients were divided into 2 groups: good prognosis group (mRS score 0-3, n=93) and poor prognosis group (mRS score 4-6, n=122).Univariate and multivariate stepwise Logistic regression analyses were used to screen the neurological prognostic influencing factors of ABAO-EVT patients 90 d after operation. Results: Logistic regression analysis showed that the baseline NIHSS score increased was a risk factor for poor prognosis of ABAO-EVT patients (aOR=0.936, 95%CI: 0.907-0.965, P=0.000; aOR=0.940, 95%CI: 0.910-0.970, P=0.000), with the first pass effect (aOR=5.752, 95%CI: 2.875-11.508; P=0.000), eTICI grade 2c-3 (aOR=7.113, 95%CI: 3.665-13.805; P=0.000) were protective factors for good prognosis. Conclusions: Low baseline NIHSS score, first pass effect and reperfusion level of eTICI 2c-3 are all protective factors for good neurological prognosis of ABAO-EVT patients.

Key words: Ischemic stroke, Basilar artery, Thrombectomy, Prognosis, Reperfusion, Risk factors, Logistic models, Multicenter study