急性基底动脉闭塞患者的闭塞部位与临床结果的关系

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-19 DOI:10.1016/j.jstrokecerebrovasdis.2025.108427

Qiuyu Su MD , Haoxuan Zhu MD , Linyu Li MD , Guojian Liu MD , Jie Yang MD , Xiaolei Shi MD , Shihai Yang MD , Jinfu Ma MD , Dahong Yang MD , Zhenxuan Tian MD , Boyu Chen MD , Chawen Ding MD , Jiaxing Song MD , Changwei Guo MD , Wenjie Zi MD , Zhao Yang MD , Zhenqian Liu MD

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引用次数: 0

摘要

目的分析急性基底动脉闭塞（ABAO）患者不同闭塞部位与临床预后的关系。患者和方法：本研究从基底动脉登记中心招募了ABAO患者，通过闭塞部位（远端、中端和近端ABAO）和治疗方式来评估结果。主要疗效以改良Rankin量表（mRS） 0-3分评定，次要疗效以mRS 0-2分和0-1分评定。安全性指标包括90天死亡率和48 h内症状性颅内出血（siich）的发生。结果血管内治疗（EVT）组经多变量回归分析，与远端闭塞相比，中端闭塞与临床结局呈显著负相关(mRS 0-3，调整优势比（aOR） 0.36, 95%置信区间（CI） 0.20-0.63, P < 0.001；mRS 0-2, aOR 0.51, 95% CI 0.29-0.91, P = 0.023)。然而，死亡率和siich在两组间无显著差异。此外，与标准药物治疗（SMT）相比，EVT患者在远端（aOR 5.56, 95% CI 1.74-17.79, P = 0.004）、中端（aOR 5.06, 95% CI 1.88-13.63, P = 0.001）和近端（aOR 3.92, 95% CI 0.94-24.05, P = 0.14） 3个闭塞部位的良好预后（mRS 0-3）显著改善。同样，倾向得分匹配（PSM）的结果与上述趋势一致。结论在EVT治疗的患者中，我们的研究结果显示，不同的闭塞部位临床结果有显著差异。此外，与SMT相比，EVT在3个闭塞部位表现出更好的临床效果。这些发现支持在ABAO治疗中根据闭塞部位确定EVT的优先级。本研究已在中国临床试验注册中心注册（ChiCTR1800014759）。

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Association between occlusion site and clinical outcomes in patients with acute basilar artery occlusion

Purpose

This study aimed to analyze the association between different occlusion sites and clinical outcomes in acute basilar artery occlusion (ABAO) patients.

Patients and methods

This study recruited ABAO patients from the BASILAR registry to evaluate outcomes by occlusion sites (distal, middle and proximal ABAO) and treatment modality. Primary effectiveness outcome was assessed by the modified Rankin Scale (mRS) score 0-3 and secondary effectiveness outcomes were mRS 0-2 and 0-1. Safety outcomes included the mortality at 90 days and the occurrence of symptomatic intracranial hemorrhage (sICH) within 48 h.

Results

In endovascular treatment (EVT) group, after multivariable regression analysis, compared to distal occlusions, middle occlusions were significantly and negatively associated with clinical outcomes (mRS 0-3, adjusted odds ratio (aOR) 0.36, 95 % confidence interval (CI) 0.20-0.63, P < 0.001; mRS 0-2, aOR 0.51, 95 % CI 0.29-0.91, P = 0.023). However, mortality and sICH did not differ significantly between groups. Additionally, compared to standard medical therapy (SMT), patients following EVT significantly improved favorable outcomes (mRS 0-3) among 3 occlusion sites: distal (aOR 5.56, 95 % CI 1.74-17.79, P = 0.004), middle (aOR 5.06, 95 % CI 1.88-13.63, P = 0.001), and proximal (aOR 3.92, 95 % CI 0.94-24.05, P = 0.14). Similarly, the results of propensity score matching (PSM) were consistent with the above trends.

Conclusion

In patients treated with EVT, our findings showed that clinical outcomes significantly differed by occlusion site. Additionally, EVT demonstrated superior clinical effectiveness among 3 occlusion sites compared to SMT. These findings support occlusion site-specific EVT prioritization in ABAO management.

This study was registered with the Chinese Clinical Trial Registry (ChiCTR1800014759).

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.