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

doi:10.3969/j.issn.1672-6731.2020.05.005

Abstract

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

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

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.

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.

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