颅内动脉粥样硬化症患者急性基底动脉闭塞的机械取栓术疗效。

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2025-01-01 Epub Date: 2024-04-29 DOI:10.1159/000539112

Huong Bich Thi Nguyen, Trung Quoc Nguyen, Vu Thanh Tran, Tra Son Vu Le, Anh Tuan Le Truong, Binh Nguyen Pham, Sang Hung Nguyen, Anit Kiran Behera, Thanh Thien Nguyen, Thang Ba Nguyen, Thanh N Nguyen, Thang Huy Nguyen

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Good functional outcome was defined as mRS ≤3 at 90 days.Results: Among the 208 patients enrolled, 112 (53.8%) patients were categorized in the ICAD group, and 96 (46.2%) in the non-ICAD group. Occlusion in the proximal segment of the basilar artery was more common in patients with ICAD (55.4% vs. 21.9%, p < 0.001), whereas the distal segment was the most common location in the non-ICAD group (58.3% vs. 10.7%, p < 0.001). Patients in the ICAD group were more likely to undergo treatment in the late window, with a higher mean onset-to-treatment time compared to the non-ICAD group (11.6 vs. 9.5 h, p = 0.01). In multivariable logistic regression analysis, distal segment BAO was negatively associated with ICAD (aOR 0.13, 95% CI: 0.05-0.32, p < 0.001), while dyslipidemia showed a positive association (aOR 2.44, 95% CI: 1.15-5.17, p = 0.02). There was a higher rate for rescue stenting in the ICAD compared to non-ICAD group (15.2% vs. 0%, p < 0.001). 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引用次数: 0

摘要

引言颅内动脉粥样硬化疾病（ICAD）已被确定为急性基底动脉闭塞（BAO）的主要病因。方法一项前瞻性队列研究于 2021 年 8 月至 2023 年 6 月在越南胡志明市 115 人民医院进行。研究纳入了在症状出现后 24 小时内接受血管内治疗的急性 BAO 患者（单纯血栓切除术或与静脉注射阿替普酶桥接）。分析了基线特征和疗效，并对有 ICAD 和无 ICAD 的患者进行了比较。90天后mRS≤3为功能良好。结果在入组的208名患者中，112人（53.8%）被归入ICAD组，96人（46.2%）被归入非ICAD组。基底动脉近段闭塞在 ICAD 患者中更为常见（55.4% vs 21.9%，p < 0.001），而远段闭塞在非 ICAD 组中最为常见（58.3% vs 10.7%，p < 0.001）。ICAD 组患者更有可能在晚期窗口期接受治疗，与非 ICAD 组患者相比，ICAD 组患者从发病到接受治疗的平均时间更长（11.6 小时 vs. 9.5 小时，P=0.01）。在多变量逻辑回归分析中，远段基底动脉闭塞与ICAD呈负相关（aOR 0.13，95% CI 0.05 - 0.32，p <0.001），而血脂异常呈正相关（aOR 2.44，95% CI 1.15 - 5.17，p = 0.02）。与非ICAD组相比，ICAD组的支架抢救率更高（15.2% vs. 0%，p <0.001）。然而，两组患者在良好预后（45.5% 对 44.8%，p = 0.91）、无症状出血率（4.5% 对 8.3%，p = 0.25）和死亡率（42% 对 50%，p = 0.25）方面无明显差异。结论 ICAD 是 BAO 患者的常见病因。基底动脉闭塞的位置段和血脂异常与 BAO 患者的 ICAD 相关。接受血管内治疗的 BAO 患者中有 ICAD 和没有 ICAD 的 90 天预后没有差异。

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Outcome of Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Patients with Intracranial Atherosclerotic Disease.

Introduction: Intracranial atherosclerotic disease (ICAD) has been identified as a major cause of acute basilar artery occlusion (BAO).This study compared the characteristics and treatment outcomes in acute BAO patients with and without ICAD.

Methods: A prospective cohort study was conducted at 115 People's Hospital, Ho Chi Minh city, Vietnam from August 2021 to June 2023. Patients with acute BAO who underwent endovascular treatment within 24 h from symptom onset were included (thrombectomy alone or bridging with intravenous alteplase). The baseline characteristics and outcomes were analyzed and compared between patients with and without ICAD. Good functional outcome was defined as mRS ≤3 at 90 days.

Results: Among the 208 patients enrolled, 112 (53.8%) patients were categorized in the ICAD group, and 96 (46.2%) in the non-ICAD group. Occlusion in the proximal segment of the basilar artery was more common in patients with ICAD (55.4% vs. 21.9%, p < 0.001), whereas the distal segment was the most common location in the non-ICAD group (58.3% vs. 10.7%, p < 0.001). Patients in the ICAD group were more likely to undergo treatment in the late window, with a higher mean onset-to-treatment time compared to the non-ICAD group (11.6 vs. 9.5 h, p = 0.01). In multivariable logistic regression analysis, distal segment BAO was negatively associated with ICAD (aOR 0.13, 95% CI: 0.05-0.32, p < 0.001), while dyslipidemia showed a positive association (aOR 2.44, 95% CI: 1.15-5.17, p = 0.02). There was a higher rate for rescue stenting in the ICAD compared to non-ICAD group (15.2% vs. 0%, p < 0.001). However, no significant differences were found between the two groups in terms of good outcome (45.5% vs. 44.8%, p = 0.91), symptomatic hemorrhage rates (4.5% vs. 8.3%, p = 0.25), and mortality (42% vs. 50%, p = 0.25).

Conclusion: ICAD was a common etiology in patients with BAO. The location segment of BAO and dyslipidemia were associated with ICAD in patients with BAO. There was no difference in 90-day outcomes between BAO patients with and without ICAD undergoing endovascular therapy.

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.