Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion
Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion
复制标题
DOI：
10.3174/ajnr.a4844
复制
发表时间：
2016-11-01
影响因子：
3.5
通讯作者：
Lee, J. S.
中科院分区：
文献类型：
--
作者：
Kim, Y. W.;Hong, J. M.;Lee, J. S.
背景和目的：虽然颅内动脉粥样硬化性疾病在急性椎基底动脉闭塞的血管内治疗中经常遇到，但其临床意义尚不清楚。我们的目的是评估颅内动脉粥样硬化性疾病是否影响急性椎基底动脉闭塞性stroke.MATERIALS和METHODS血管内治疗后的临床结局：51例急性椎基底动脉闭塞性卒中患者被纳入。发作至腹股沟穿刺时间为12小时，采用抽吸或基于支架的血栓切除术作为主要治疗方法。初次血管内治疗后，当在闭塞部位观察到固定局灶性狭窄时，血管造影诊断为颅内动脉粥样硬化疾病（IAD组），而如果未观察到狭窄，则诊断为栓塞（栓塞组）。两组的临床和治疗变量进行了比较，IAD作为临床outcome.RESULTS预后因素进行了评估：基线NIHSS评分倾向于较低（14比22，P = 0.097）在IAD组（n = 19）比栓塞组（n = 32）。尽管TICI 2b-3的发生率相似（89.5% vs 87.5%，P = 1.000），但IAD组的手术时间更长（96 vs 61分钟，P = 0.002）。IAD组第7天时的NIHSS评分较高（21比8，P = .060），不良结局（3个月时mRS 4-6）更常见（73.7%比43.8%，P = .038）。IAD（优势比，5.469; 95%CI，1.09-27.58; P = 0.040）与不良结局独立相关。结论：与IAD相关的动脉闭塞与较长的手术时间和较差的临床结局相关。需要进一步研究来阐明适当的血管内策略。
BACKGROUND AND PURPOSE: Although intracranial atherosclerotic disease is often encountered during endovascular treatment for acute vertebrobasilar occlusions, its clinical implication is not well-known. We aimed to evaluate whether intracranial atherosclerotic disease influences the clinical outcomes following endovascular treatment of acute vertebrobasilar occlusive stroke.MATERIALS AND METHODS: Fifty-one patients with acute vertebrobasilar occlusive stroke were included. The onset-to-groin puncture time was 12 hours, and aspiration- or stent-based thrombectomy was used as the primary treatment method. Following primary endovascular treatment, intracranial atherosclerotic disease (IAD group) was angiographically diagnosed when a fixed focal stenosis was observed at the occlusion site, whereas embolism (embolic group) was diagnosed if no stenosis was observed. Clinical and treatment variables were compared in both groups, and IAD was evaluated as a prognostic factor for clinical outcomes.RESULTS: The baseline NIHSS score tended to be lower (14 versus 22, P = .097) in the IAD group (n = 19) than in the embolic group (n = 32). The procedural time was longer in the IAD group (96 versus 61 minutes, P = .002), despite similar rates of TICI 2b-3 (89.5% versus 87.5%, P = 1.000). The NIHSS score at 7 days was higher (21 versus 8, P = .060) and poor outcomes (mRS 4-6 at 3 months) were more frequent in the IAD group (73.7% versus 43.8%, P = .038). IAD (odds ratio, 5.469; 95% CI, 1.09-27.58; P = .040) was independently associated with poor outcomes.CONCLUSIONS: An arterial occlusion related to IAD was associated with a longer procedural time and poorer clinical outcome. Further studies are warranted to elucidate the appropriate endovascular strategy.