Thrombolytic therapy of acute basilar artery occlusion - Variables affecting recanalization and outcome
Thrombolytic therapy of acute basilar artery occlusion - Variables affecting recanalization and outcome
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DOI：
10.1161/01.str.27.5.875
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发表时间：
1996-05-01
期刊：
影响因子：
8.3
通讯作者：
Hacke, W
中科院分区：
文献类型：
--
作者：
Brandt, T;vonKummer, R;Hacke, W
背景和目的溶栓治疗可降低急性基底动脉闭塞后的死亡率。我们的目的是找到变量影响再通和临床结果的患者与BA闭塞溶栓therapy.Methods我们分析了回顾性的临床和血管造影数据的连续系列的51例动脉内尿激酶（n = 44; 0.3至1.5 mIU）或静脉或动脉内重组组织纤溶酶原激活剂（n = 7; 22至100 mg）。结果闭塞部位分别为BA尾段（n = 23）、中段（n = 18）和远段（n = 10）。发病原因为栓塞35例，局部动脉粥样硬化血栓形成16例。侧支循环良好者32例，侧支循环差或缺失者19例。51例患者中有26例（51%）实现了再通，与栓塞性闭塞相关（P = 0.0025）。再通组和非再通组的死亡率分别为46%（12/26）和92%（23/25）（P = 0.0004）。影响死亡率的其他独立变量是BA梗阻长度（P = .0011）、年龄（P = .0008）和侧支循环状态（P = .0454）。随访（中位数，32个月）后，16名幸存者中有10名仅轻度受损，Barthel指数评分为95或更高; 5例中度和1例重度disable.Conclusions急性BA闭塞再通降低死亡率显着。BA阻塞的长度和侧支循环的状态是影响生存率的另外的独立变量。年轻的BA单节段栓塞闭塞患者似乎有最好的机会从溶栓中获益。
Background and Purpose Thrombolysis may reduce mortality after acute basilar artery (BA) occlusion. We intended to find variables affecting recanalization and clinical outcome in patients with BA occlusion undergoing thrombolytic therapy.Methods We analyzed in retrospect the clinical and angiographic data of a consecutive series of 51 patients treated with intra-arterial urokinase (n = 44; 0.3 to 1.5 mIU) or intravenous or intra-arterial recombinant tissue plasminogen activator (n = 7; 22 to 100 mg). We identified effective variables by multiple logistic regression analyses and univariate tests.Results Sites of occlusion were the caudal (n = 23), middle (n = 18), and distal (n = 10) segments of the BA. The pathogenesis was embolism in 35 and local atherothrombosis in 16 patients. Collateral circulation was good in 32 patients and poor or absent in 19 patients. Recanalization was achieved in 26 of 51 (51%) patients and was associated with occlusions of embolic etiology (P = .0025). Mortality was 46% (12/26)in the recanalization group and 92% (23/25) in the nonrecanalization group (P = .0004). Other independent variables affecting mortality were length of BA obstruction (P = .0011), age (P = .0008), and collateral state (P = .0454). After follow-up (median, 32 months), 10 of the 16 survivors were only minimally impaired, with a Barthel Index score of 95 or greater; 5 patients were moderately and 1 severely disabled.Conclusions Recanalization of acute BA occlusion reduces mortality significantly. Length of BA obstruction and state of the collaterals are additional independent variables affecting survival. Young patients with monosegmental embolic occlusion of the BA seem to have the best chance to considerably profit from thrombolysis.