Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion
Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion
复制标题
基线后循环急性卒中预后早期计算机断层扫描评分对于急性基底动脉闭塞治疗决策的价值
DOI：
10.1161/strokeaha.120.031371
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发表时间：
2021-03-01
期刊：
影响因子：
8.3
通讯作者：
Li, Fangfei
中科院分区：
文献类型：
--
作者：
Sang, Hongfei;Li, Fengli;Li, Fangfei
补充数字内容可在文本中找到。背景和目的：本研究旨在分析基线后循环急性卒中预后早期计算机断层扫描评分（pc-ASPECTS）对急性基底动脉闭塞患者血管内治疗（EVT）的有效性和安全性的影响。研究方法：BASILAR是一项全国性的前瞻性登记研究，纳入了症状发作24小时内经影像学证实的有症状急性基底动脉闭塞的连续患者。我们评估了单纯标准药物治疗（SMT组）与SMT加EVT（EVT组）对非造影CT证实的pc-ASPECTS患者的影响，作为分类（0-4 vs 5-7 vs 8-10）和连续变量。主要结局包括90天时良好的功能结局（改良兰金量表≤3）和90天内的死亡率。结果如下：共纳入823例病例：468例pc-ASPECTS 8 - 10（SMT：71; EVT：397），317例pc-ASPECTS 5 - 7（SMT：85; EVT：232），38例pc-ASPECTS 0 - 4（SMT：13; EVT：25）。EVT与更高的有利结局率相关（调整后的相对风险，95% CI分别为4.35 [1.30-14.48]和3.20 [1.68-6.09]）和较低的死亡率在pc-ASPECTS 5 - 7和8 - 10亚组中，分别为60.8%和77.6%，P=0.005和35.0%和66.2%，P<0.001。连续获益曲线也显示，在pc-ASPECTS ≥5的患者中，EVT的疗效和安全性上级SMT。此外，校正pc-ASPECTS后，发作至穿刺时间对EVT有利结局的预后影响不显著（校正比值比，0. 98 [95% CI，0. 94 - 1. 02]）。结论：对于pc-ASPECTS ≥5分的基底动脉闭塞患者，EVT治疗可获得较好的疗效。基线pc-ASPECTS对于决策制定和预测预后比至EVT的时间更重要。注册：URL：http://www.chictr.org.cn.唯一标识符：ChiCTR 1800014759。
Supplemental Digital Content is available in the text. Background and Purpose: This study aimed to analyze the impact of baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) on the efficacy and safety of endovascular therapy (EVT) for patients with acute basilar artery occlusion. Methods: The BASILAR was a nationwide prospective registry of consecutive patients with a symptomatic and radiologically confirmed acute basilar artery occlusion within 24 hours of symptom onset. We estimated the effect of standard medical therapy alone (SMT group) versus SMT plus EVT (EVT group) for patients with documented pc-ASPECTS on noncontrast CT, both as a categorical (0–4 versus 5–7 versus 8–10) and as a continuous variable. The primary outcomes included favorable functional outcomes (modified Rankin Scale ≤3) at 90 days and mortality within 90 days. Results: In total, 823 cases were included: 468 with pc-ASPECTS 8 to 10 (SMT: 71; EVT: 397), 317 with pc-ASPECTS 5 to 7 (SMT: 85; EVT: 232), and 38 with pc-ASPECTS 0 to 4 (SMT: 13; EVT: 25). EVT was associated with higher rate of favorable outcomes (adjusted relative risk with 95% CI, 4.35 [1.30–14.48] and 3.20 [1.68–6.09]; respectively) and lower mortality (60.8% versus 77.6%, P=0.005 and 35.0% versus 66.2%, P<0.001; respectively) than SMT in the pc-ASPECTS 5 to 7 and 8 to 10 subgroups. Continuous benefit curves also showed the superior efficacy and safety of EVT over SMT in patients with pc-ASPECTS ≥5. Furthermore, the prognostic effect of onset to puncture time on favorable outcome with EVT was not significant after adjustment for pc-ASPECTS (adjusted odds ratio, 0.98 [95% CI, 0.94–1.02]). Conclusions: Patients of basilar artery occlusion with pc-ASPECTS ≥5 could benefit from EVT. The baseline pc-ASPECTS appears more important for decision making and predicting prognosis than time to EVT. Registration: URL: http://www.chictr.org.cn. Unique identifier: ChiCTR1800014759.