Glycoprotein IIb/IIIa Inhibitor Bridging and Subsequent Endovascular Therapy in Vertebrobasilar Occlusion in 120 Patients
Glycoprotein IIb/IIIa Inhibitor Bridging and Subsequent Endovascular Therapy in Vertebrobasilar Occlusion in 120 Patients
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DOI：
10.1007/s00062-014-0341-3
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发表时间：
2016-06-01
影响因子：
2.8
通讯作者：
Eckert, B.
中科院分区：
文献类型：
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作者：
Ernst, M.;Butscheid, F.;Eckert, B.
急性椎基底动脉闭塞(VBO)的治疗模式尚不明确。我们分析了静脉注射糖蛋白IIb/IIIa抑制剂(IVGPI)加动脉内溶栓加或不加血管内机械治疗(经皮腔内血管成形术/支架或血栓抽吸术)的有效性和安全性，并寻找预测良好临床结果的治疗因素。多因素Logistic回归分析表明，影响预后的独立因素包括意识水平、年龄、性别、血管造影时间、GPI制剂、入院方式、闭塞类型、血管再通成功率和血管内治疗模式。临床随访分为无至中度残疾(MRS)0-3分和重度残疾或死亡(MRS 4-6)两组。入院时美国国立卫生研究院卒中评分(NIHSS)为32分，平均NIHSS评分为24分。共有49名患者(41%)发展为无至中度残疾(MRS 0-3)，39名患者(33%)死亡。心肌梗死溶栓再通成功率2/3者97例(80.8%)。症状性脑出血11例(9%)。轻度意识障碍(P<；0.001)和栓塞型(P=0.01)是良好预后的显著预测因素。再通患者的临床结果较好，但无统计学意义(p=0.055)。我们的结果表明，静脉GPI和随后的血管内治疗相结合可能是治疗急性VBO的一种有效策略。采用这种治疗方法，治疗前保持警觉和血栓闭塞类型与无至中度残疾相关。
The treatment mode in acute vertebrobasilar occlusion (VBO) remains uncertain. We analyzed efficacy and safety of intravenous glycoprotein IIb/IIIa inhibitor (IV GPI) plus subsequent intra-arterial thrombolysis with or without additional endovascular mechanical therapy (percutaneous transluminal angioplasty/stenting or thrombus aspiration) and sought treatment factors that predict good clinical outcome.We retrospectively analyzed 120 cases of patients with angiographically proven acute VBO. Multivariate logistic regression was used to identify independent predictors for clinical outcome and included level of consciousness, age, sex, time to angiography, GPI agent, admission mode, occlusion type, recanalization success, and endovascular treatment mode. Clinical follow-up was dichotomized in no to moderate disability (modified Rankin scale (mRS) 0-3) vs. severe disability or death (mRS 4-6).Median National Institutes of Health stroke scale (NIHSS) score on admission was 32, and mean NIHSS score was 24. A total of 49 patients (41 %) developed no to moderate disability (mRS 0-3), and 39 patients (33 %) died. Thrombolysis in myocardial infarction 2/3 recanalization success was achieved in 97 patients (80.8 %). Symptomatic intracerebral hemorrhages occurred in 11 patients (9 %). Mild impairment of consciousness (p < 0.001) and embolic occlusion type (p = 0.01) were significant predictors of favorable outcome. Clinical outcome in recanalized patients was better, but not statistically significant (p = 0.055).Our results indicate that combined therapy with IV GPI and subsequent endovascular therapy may be a valid treatment strategy in acute VBO. With this treatment approach, a preserved vigilance before treatment and an embolic occlusion type are associated with no to moderate disability.