Analysis of influence factors for unfavorable prognosis in acute basilar artery occlusion treated with endovascular thrombectomy

doi:10.3969/j.issn.1672-6731.2020.05.006

Abstract

Abstract:

Objective To screen the risk factors related to unfavorable prognosis and evaluate the predictive effect of four imaging scoring systems on the unfavorable prognosis in the patients with acute basilar artery occlusion (BAO) after endovascular thrombectomy. Methods From March 2012 to August 2018, a total of 57 patients with acute BAO were treated with endovascular thrombectomy, preoperative DWI Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), DWI Brain Stem Score (BSS), Posterior Circulation CTA (pc-CTA) and Basilar Artery CTA (BATMAN) were used. Thrombolysis in Cerebral Infarction (TICI) was used to evaluate the incidence of vascular recanalization. The incidence of symptomatic intracranial hemorrhage (sICH) was recorded within 36 h. The prognosis was evaluated by modified Rankin Scale (mRS) at 3 months. Univariate and multivariate backward Logistic regression analysis were used to screen the risk factors related to the unfavoriable prognosis in the patients with acute BAO after endovascular thrombectomy. Receiver operating characteristic curve (ROC) was used to calculate the area under the curve (AUC), and evaluate the predictive value of DWI pc-ASPECTS, DWI BSS, pc-CTA and BATMAN scores for prognosis. Results In 57 patients, 53 patients (92.98%) had successful recanalization, 2 (3.51%) had partial recanalization, 2 (3.51%) had no recanalization, 3 (5.26%) had sICH, 22 (38.60%) had good prognosis, 35 (61.40%) had poor prognosis, and 14 (24.56%) died. After univariate and multivariate backward Logistic regression analysis, higher NIHSS score on admission (OR=0.879, 95% CI:0.783-0.986; P=0.028), higher DWI BSS score (OR=0.348, 95% CI:0.177-0.683; P=0.002) and lower BATMAN score (OR=1.549, 95% CI:1.019-2.353; P=0.040) were risk factors for unfavorable prognosis of patients with acute BAO after endovascular thrombectomy. ROC analysis of the four radiographic scoring systems showed that the AUC of DWI pc-ASPECTS, DWI BSS, pc-CTA and BATMAN score were 0.787 (95% CI:0.658-0.884, P=0.000), 0.861 (95% CI:0.744-0.938, P=0.000), 0.634 (95% CI:0.496-0.757, P=0.091) and 0.698 (95% CI:0.562-0.813, P=0.012), respectively. Conclusions Higher NIHSS score on admission, higher DWI BSS score and lower BATMAN score are risk factors for unfavorable prognosis of acute BAO treated with endovascular thrombectomy.

Key words: Stroke, Brain ischemia, Arterial Occlusive diseases, Stents, Diffusion magnetic resonance imaging, Tomography, X-ray computed, Risk factors, Logistic models

摘要：

目的筛查急性基底动脉闭塞血管内支架取栓术后预后不良的危险因素，并评价4种影像学评分系统的预测价值。方法 2012年3月至2018年8月共57例急性基底动脉闭塞患者均行血管内支架取栓术，术前行DWI后循环Alberta脑卒中计划早期CT评分（pc-ASPECTS）、DWI脑干评分（BSS）、后循环CTA评分（pc-CTA）和基底动脉CTA评分（BATMAN），术后即刻采用脑梗死溶栓血流分级（TICI）评价血管再通，术后36 h内记录症状性颅内出血发生率，发病后3个月采用改良Rankin量表（mRS）评价预后。单因素和多因素Logistic回归分析筛查急性基底动脉闭塞血管内支架取栓术后预后不良的危险因素。绘制受试者工作特征曲线（ROC）并计算曲线下面积，评价DWI pc-ASPECTS、DWIBSS、pc-CTA和BATMAN评分的预测价值。结果 57例患者中53例（92.98%）血管完全再通，2例（3.51%）部分再通，2例（3.51%）未再通；3例（5.26%）症状性颅内出血；22例（38.60%）预后良好、35例（61.40%）预后不良；14例（24.56%）死亡。Logistic回归分析，入院时高NIHSS评分（OR=0.879，95% CI：0.783~0.986；P=0.028）、高DWI BSS评分（OR=0.348，95% CI：0.177~0.683；P=0.002）和低BATMAN评分（OR=1.549，95% CI：1.019~2.353；P=0.040）是急性基底动脉闭塞血管内治疗后预后不良的危险因素。ROC曲线，DWI pc-ASPECTS、DWI BSS、pc-CTA和BATMAN评分曲线下面积分别为0.787（95% CI：0.658~0.884，P=0.000）、0.861（95% CI：0.744~0.938，P=0.000）、0.634（95% CI：0.496~0.757，P=0.091）和0.698（95% CI：0.562~0.813，P=0.012）。结论入院时高NIHSS评分、高DWI BSS评分和低BATMAN评分是急性基底动脉闭塞血管内治疗后预后不良的危险因素。

关键词: 卒中, 脑缺血, 动脉闭塞性疾病, 支架, 弥散磁共振成像, 体层摄影术, X 线计算机, 危险因素, Logistic 模型

YANG Hai-hua, MA Ning, LIU Lian, MIAO Zhong-rong. Analysis of influence factors for unfavorable prognosis in acute basilar artery occlusion treated with endovascular thrombectomy[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 399-406.

杨海华, 马宁, 刘恋, 缪中荣. 急性基底动脉闭塞血管内治疗不良结局的影响因素分析[J]. 中国现代神经疾病杂志, 2020, 20(5): 399-406.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2020.05.006

https://journal11.magtechjournal.com/cjcnn/EN/Y2020/V20/I5/399

References

[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] 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.
[3] van Houwelingen RC, Luijckx GJ, Mazuri A, Bokkers RP, Eshghi OS, Uyttenboogaart M. Safety and outcome of intra-arterial treatment for basilar artery occlusion[J]. JAMA Neurol, 2016, 73:1225-1230.
[4] 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.
[5] Mokin M, Sonig A, Sivakanthan S, Ren Z, Elijovich L, Arthur A, Goyal N, Kan P, Duckworth E, Veznedaroglu E, Binning MJ, Liebman KM, Rao V, Turner RD 4th, Turk AS, Baxter BW, Dabus G, Linfante I, Snyder KV, Levy EI, Siddiqui AH. Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes[J]. Stroke, 2016, 47:782-788.
[6] Vergouwen MD, Algra A, Pfefferkorn T, Weimar C, Rueckert CM, Thijs V, Kappelle LJ, Schonewille WJ; Basilar Artery International Cooperation Study (BASICS) Study Group. Time is brain (stem) in basilar artery occlusion[J]. Stroke, 2012, 43:3003-3006.
[7] Alemseged F, Shah DG, Diomedi M, Sallustio F, Bivard A, Sharma G, Mitchell PJ, Dowling RJ, Bush S, Yan B, Caltagirone C, Floris R, Parsons MW, Levi CR, Davis SM, Campbell BC. The basilar artery on computed tomography angiography prognostic score for basilar artery occlusion[J]. Stroke, 2017, 48:631-637.
[8] van der Hoeven EJ, McVerry F, Vos JA, Algra A, Puetz V, Kappelle LJ, Schonewille WJ; BASICS Registry Investigators. Collateral flow predicts outcome after basilar artery occlusion:the posterior circulation collateral score[J]. Int J Stroke, 2016, 11:768-775.
[9] Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O'Reilly C, Barber PA, Sharma P, Goyal M, Gahn G, von Kummer R, Demchuk AM. Extent of hypoattenuation on ct angiography source images predicts functional outcome in patients with basilar artery occlusion[J]. Stroke, 2008, 39:2485-2490.
[10] Tei H, Uchiyama S, Usui T, Ohara K. Posterior circulation aspects on diffusion-weighted mri can be a powerful marker for predicting functional outcome[J]. J Neurol, 2010, 257:767-773.
[11] Mourand I, Machi P, Nogué E, Arquizan C, Costalat V, Picot MC, Bonafé A, Milhaud D. Diffusion-weighted imaging score of the brain stem:a predictor of outcome in acute basilar artery occlusion treated with the solitaire fr device[J]. AJNR Am J Neuroradiol, 2014, 35:1117-1123.
[12] Da Ros V, Meschini A, Gandini R, Del Giudice C, Garaci F, Stanzione P, Rizzato B, Diomedi M, Simonetti G, Floris R, Sallustio F. Proposal for a vascular computed tomography-based grading system in posterior circulation stroke:a single-center experience[J]. J Stroke Cerebrovasc Dis, 2016, 25:368-377.
[13] Recommendations on stroke prevention, diagnosis, and therapy:report of the who task force on stroke and other cerebrovascular disorders[J]. Stroke, 1989, 20:1407-1431.
[14] 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.
[15] Nagel S, Herweh C, Köhrmann M, Huttner HB, Poli S, Hartmann M, Hähnel S, Steiner T, Ringleb P, Hacke W. MRI in patients with acute basilar artery occlusion:DWI lesion scoring is an independent predictor of outcome[J]. Int J Stroke, 2012, 7:282-288.

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