Yi Yan, Kemeng Zhang, Wansi Zhong, Shenqiang Yan, Bing Zhang, Jianhua Cheng, Min Lou
{"title":"急性基底动脉闭塞患者血管内介入治疗后无效再通畅的影响因素。","authors":"Yi Yan, Kemeng Zhang, Wansi Zhong, Shenqiang Yan, Bing Zhang, Jianhua Cheng, Min Lou","doi":"10.3724/zdxbyxb-2023-0425","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To explore the influence factors for futile recanalization following endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO).</p><p><strong>Methods: </strong>Clinical data of patients with acute BAO, who underwent endovascular treatment within 24 h of onset from January 2017 to November 2022, were retrospectively analyzed. The futile recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) grade ≥2b or 3 after successful reperfusion, but the modified Rankin Scale score >2 at 3 months after EVT. Binary logistic regression model was used to analyze the influencing factors of futile recanalization.</p><p><strong>Results: </strong>A total of 471 patients with a median age of 68 (57, 74) years were included and 68.9% were males, among whom 298 (63.27%) experienced futile recanalization. Multivariate analysis revealed that concomitant atrial fibrillation (<i>OR</i>=0.456, 95%<i>CI</i>: 0.282-0.737, <i>P</i><0.01), bridging thrombolysis (<i>OR</i>=0.640, 95%<i>CI</i>: 0.416-0.985, <i>P</i><0.05), achieving mTICI grade 3 (<i>OR</i>=0.554, 95%<i>CI</i>: 0.334-0.918, <i>P</i><0.05), arterial occlusive lesion (AOL) grade 3 (<i>OR</i>=0.521, 95%<i>CI</i>: 0.326-0.834, <i>P</i><0.01), and early postoperative statin therapy (<i>OR</i>=0.509, 95%<i>CI</i>: 0.273-0.948, <i>P</i><0.05) were protective factors for futile recanalization after EVT in acute BAO patients. High baseline National Institutes of Health Stroke Scale (NIHSS) score (<i>OR</i>=1.068, 95%<i>CI</i>: 1.049-1.087, <i>P</i><0.01), coexisting hypertension (<i>OR</i>=1.571, 95%<i>CI</i>: 1.017-2.427, <i>P</i><0.05), multiple retrieval attempts (<i>OR</i>=1.237, 95%<i>CI</i>: 1.029-1.488, <i>P</i><0.05) and postoperative hemorrhagic transformation (<i>OR</i>=8.497, 95%<i>CI</i>: 2.879-25.076, <i>P</i><0.01) were risk factors. For trial of ORG 10172 in acute stroke treatment (TOAST) classification, cardiogenic embolism (<i>OR</i>=0.321, 95%<i>CI</i>: 0.193-0.534, <i>P</i><0.01) and other types (<i>OR</i>=0.499, 95%<i>CI</i>: 0.260-0.961, <i>P</i><0.05) were related to lower incidence of futile recanalization.</p><p><strong>Conclusions: </strong>The incidence of futile recanalization after EVT in patients with acute BAO is high. Bridging venous thrombolysis before operation and an early postoperative statin therapy may reduce the incidence of futile recanalization.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057989/pdf/","citationCount":"0","resultStr":"{\"title\":\"Influencing factors of futile recanalization after endovascular intervention in patients with acute basilar artery occlusion.\",\"authors\":\"Yi Yan, Kemeng Zhang, Wansi Zhong, Shenqiang Yan, Bing Zhang, Jianhua Cheng, Min Lou\",\"doi\":\"10.3724/zdxbyxb-2023-0425\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To explore the influence factors for futile recanalization following endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO).</p><p><strong>Methods: </strong>Clinical data of patients with acute BAO, who underwent endovascular treatment within 24 h of onset from January 2017 to November 2022, were retrospectively analyzed. The futile recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) grade ≥2b or 3 after successful reperfusion, but the modified Rankin Scale score >2 at 3 months after EVT. Binary logistic regression model was used to analyze the influencing factors of futile recanalization.</p><p><strong>Results: </strong>A total of 471 patients with a median age of 68 (57, 74) years were included and 68.9% were males, among whom 298 (63.27%) experienced futile recanalization. Multivariate analysis revealed that concomitant atrial fibrillation (<i>OR</i>=0.456, 95%<i>CI</i>: 0.282-0.737, <i>P</i><0.01), bridging thrombolysis (<i>OR</i>=0.640, 95%<i>CI</i>: 0.416-0.985, <i>P</i><0.05), achieving mTICI grade 3 (<i>OR</i>=0.554, 95%<i>CI</i>: 0.334-0.918, <i>P</i><0.05), arterial occlusive lesion (AOL) grade 3 (<i>OR</i>=0.521, 95%<i>CI</i>: 0.326-0.834, <i>P</i><0.01), and early postoperative statin therapy (<i>OR</i>=0.509, 95%<i>CI</i>: 0.273-0.948, <i>P</i><0.05) were protective factors for futile recanalization after EVT in acute BAO patients. High baseline National Institutes of Health Stroke Scale (NIHSS) score (<i>OR</i>=1.068, 95%<i>CI</i>: 1.049-1.087, <i>P</i><0.01), coexisting hypertension (<i>OR</i>=1.571, 95%<i>CI</i>: 1.017-2.427, <i>P</i><0.05), multiple retrieval attempts (<i>OR</i>=1.237, 95%<i>CI</i>: 1.029-1.488, <i>P</i><0.05) and postoperative hemorrhagic transformation (<i>OR</i>=8.497, 95%<i>CI</i>: 2.879-25.076, <i>P</i><0.01) were risk factors. For trial of ORG 10172 in acute stroke treatment (TOAST) classification, cardiogenic embolism (<i>OR</i>=0.321, 95%<i>CI</i>: 0.193-0.534, <i>P</i><0.01) and other types (<i>OR</i>=0.499, 95%<i>CI</i>: 0.260-0.961, <i>P</i><0.05) were related to lower incidence of futile recanalization.</p><p><strong>Conclusions: </strong>The incidence of futile recanalization after EVT in patients with acute BAO is high. Bridging venous thrombolysis before operation and an early postoperative statin therapy may reduce the incidence of futile recanalization.</p>\",\"PeriodicalId\":24007,\"journal\":{\"name\":\"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-04-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057989/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3724/zdxbyxb-2023-0425\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3724/zdxbyxb-2023-0425","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的探讨急性基底动脉闭塞（BAO）患者血管内治疗（EVT）后无效再通畅的影响因素：回顾性分析2017年1月至2022年11月期间发病24小时内接受血管内治疗的急性基底动脉闭塞患者的临床数据。无用再通指成功再灌注后改良脑梗死溶栓治疗（mTICI）≥2b或3，但EVT后90d改良Rankin量表评分>2。采用二元逻辑回归模型分析无效再通的影响因素：结果：共纳入了 471 例 BAO 患者，中位年龄为 68（57-74）岁，68.9% 为男性，其中 298 例（63.27%）患者经历了无效再通。多变量分析显示，并发心房颤动（OR=0.456，95%CI：0.287-0.737，POR=0.640，95%CI：0.416-0.985，POR=0.554，95%CI：0.334-0.918，POR=0.521，95%CI：0.326-0.834，POR=0.509，95%CI：0.273-0.948，POR=1.068，95%CI：1.049-1.087，POR=1.571，95%CI：1.017-2.427，POR=1.237，95%CI：1.029-1.488，POR=8.497，95%CI：2.879-25.076，POR=0.321，95%CI：0.193-0.534，POR=0.499，95%CI：0.260-0.961，PConclusions：急性 BAO 患者 EVT 后无效再通的发生率很高。术前桥接静脉溶栓和术后早期他汀类药物治疗可降低无效再通的发生率。
Influencing factors of futile recanalization after endovascular intervention in patients with acute basilar artery occlusion.
Objectives: To explore the influence factors for futile recanalization following endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO).
Methods: Clinical data of patients with acute BAO, who underwent endovascular treatment within 24 h of onset from January 2017 to November 2022, were retrospectively analyzed. The futile recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) grade ≥2b or 3 after successful reperfusion, but the modified Rankin Scale score >2 at 3 months after EVT. Binary logistic regression model was used to analyze the influencing factors of futile recanalization.
Results: A total of 471 patients with a median age of 68 (57, 74) years were included and 68.9% were males, among whom 298 (63.27%) experienced futile recanalization. Multivariate analysis revealed that concomitant atrial fibrillation (OR=0.456, 95%CI: 0.282-0.737, P<0.01), bridging thrombolysis (OR=0.640, 95%CI: 0.416-0.985, P<0.05), achieving mTICI grade 3 (OR=0.554, 95%CI: 0.334-0.918, P<0.05), arterial occlusive lesion (AOL) grade 3 (OR=0.521, 95%CI: 0.326-0.834, P<0.01), and early postoperative statin therapy (OR=0.509, 95%CI: 0.273-0.948, P<0.05) were protective factors for futile recanalization after EVT in acute BAO patients. High baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=1.068, 95%CI: 1.049-1.087, P<0.01), coexisting hypertension (OR=1.571, 95%CI: 1.017-2.427, P<0.05), multiple retrieval attempts (OR=1.237, 95%CI: 1.029-1.488, P<0.05) and postoperative hemorrhagic transformation (OR=8.497, 95%CI: 2.879-25.076, P<0.01) were risk factors. For trial of ORG 10172 in acute stroke treatment (TOAST) classification, cardiogenic embolism (OR=0.321, 95%CI: 0.193-0.534, P<0.01) and other types (OR=0.499, 95%CI: 0.260-0.961, P<0.05) were related to lower incidence of futile recanalization.
Conclusions: The incidence of futile recanalization after EVT in patients with acute BAO is high. Bridging venous thrombolysis before operation and an early postoperative statin therapy may reduce the incidence of futile recanalization.
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