Association of pretreatment pontine infarction with extremely poor outcome after endovascular thrombectomy in acute basilar artery occlusion
Association of pretreatment pontine infarction with extremely poor outcome after endovascular thrombectomy in acute basilar artery occlusion
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DOI：
10.1136/neurintsurg-2020-015930
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发表时间：
2021-02-01
影响因子：
4.8
通讯作者：
Park, Man Seok
中科院分区：
文献类型：
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作者：
Yoon, Woong;Baek, Byung Hyun;Park, Man Seok
背景对于急性基底动脉闭塞（BAO）患者，治疗前脑干梗死与血栓切除结果之间的关联仍有待阐明。我们的目的是评估治疗前桥脑梗死与因急性 BAO 接受血管内血栓切除术的患者的极差预后之间的关联。方法我们回顾性审查了卒中数据库中的数据，以确定 2011 年 1 月至 2019 年 8 月期间接受血栓切除术的急性 BAO 患者。患者特征、治疗前弥散加权成像 (DWI) 数据和结果 评价。最大梗塞核心表示为显示最大病变的DWI切片上每个脑干区域中梗塞核心面积的百分比。极差结果定义为 90 天改良 Rankin 量表评分为 5 或 6 分。结果 总共纳入 113 名患者，其中 37 名患者结果极差。在15名广泛脑桥梗死患者（最大脑桥梗死核心≥70%）中，93.3%的患者预后极差。多变量逻辑回归分析显示，以下变量是极差预后的独立预测因素：广泛脑桥梗死（调整后 OR 22.494；95% CI 2.335 至 216.689；p=0.007）、DWI 后循环 ASPECTS（调整后 OR 每减少 1 点 1.744；95% CI 1.197 至 2.541； p=0.004), 年龄 （调整后的 OR 每 1 年增加 1.067；95% CI 1.009 至 1.128；p=0.023）和基线 NIHSS（调整后的 OR 每增加 1 点 1.105；95% CI 1.004 至 1.216；p=0.040）。 70% 的治疗前 DWI 与患者的极差预后密切相关 急性 BAO 接受血管内血栓切除术治疗。
BackgroundThe association between pretreatment brain stem infarction and thrombectomy outcomes remains to be elucidated in patients with acute basilar artery occlusion (BAO). We aimed to assess the association between pretreatment pontine infarction and extremely poor outcome in patients who underwent endovascular thrombectomy due to acute BAO.MethodsWe retrospectively reviewed data from a stroke database to identify patients with acute BAO who underwent thrombectomy between January 2011 and August 2019. Patient characteristics, pretreatment diffusion-weighted imaging (DWI) data, and outcomes were evaluated. The largest infarct core was expressed as the percentage of infarct core area in each brain stem region on the DWI slice displaying the largest lesion. Extremely poor outcome was defined as a 90-day modified Rankin Scale score of 5 or 6.ResultsA total of 113 patients were included, 37 of whom had extremely poor outcome. Among the 15 patients with extensive pontine infarction (largest pontine infarct core of >= 70%), 93.3% had extremely poor outcome. Multivariate logistic regression analysis revealed that the following variables were independent predictors of extremely poor outcome: extensive pontine infarction (adjusted OR 22.494; 95% CI 2.335 to 216.689; p=0.007), posterior circulation ASPECTS on DWI (adjusted OR per 1-point decrease 1.744; 95% CI 1.197 to 2.541; p=0.004), age (adjusted OR per 1-year increase 1.067; 95% CI 1.009 to 1.128; p=0.023), and baseline NIHSS (adjusted OR per 1-point increase 1.105; 95% CI 1.004 to 1.216; p=0.040).ConclusionOur results showed that a large pontine infarct core of >= 70% on pretreatment DWI was strongly associated with extremely poor outcome among patients treated with endovascular thrombectomy for acute BAO.