年轻急性椎基底动脉闭塞患者的血管内血栓切除术。

IF 1.5 4区医学 Q3 CLINICAL NEUROLOGY

Neurological Research Pub Date : 2025-09-04 DOI:10.1080/01616412.2025.2549034

Zhiwen Geng, Juan Du, Chengcheng Cui, Lulu Xiao, Qingting Hu, Wen Sun, Wenya Lan, Chengqun Wei

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引用次数: 0

摘要

背景和目的：青年人急性椎基底动脉闭塞（VBAO）的血管内血栓切除术（EVT）的数据有限。我们比较了年轻和老年患者EVT后的临床特征和结果。方法：采用多中心回顾性登记，我们分析了接受EVT治疗急性VBAO的患者。患者按年龄分为两组（18-44岁vs≥45岁）。主要结果为90天和1年的功能独立性（修正Rankin量表评分，mRS 0-2）。次要结局包括再灌注成功、24小时/出院美国国立卫生研究院卒中量表（NIHSS）评分、早期神经功能改变、90天/1年mRS分布、症状性颅内出血（sICH）和死亡率。多变量逻辑回归调整混杂因素评估关联。评估年龄组与高血压/糖尿病/心房颤动的相互作用。结果：518例患者中，年龄18-44岁37例（7.1%）；年轻患者的心血管合并症较少。年轻患者的病因差异更大（大动脉粥样硬化：35.1%，其他确定原因：35.1%）。年轻患者更常在90天和1年（未调整）时获得早期神经系统改善和功能独立。校正分析显示，年龄二分类与90天（aOR 1.15, 95% CI 0.50-2.64, p = 0.74）或1年（aOR 1.59, 95% CI 0.68-3.72, p = 0.286）功能独立性无显著相关性。在90天的功能独立性中，高血压与年龄之间存在显著的相互作用（p = 0.014），在其他合并症或1年时，没有发现显著的相互作用。两组之间的死亡率和siich发生率具有可比性。结论：EVT对年轻和老年VBAO患者的疗效相当，尤其对病因异质性更强的年轻患者具有重要价值。

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Endovascular thrombectomy in young patients with acute vertebrobasilar artery occlusion.

Background and purpose: Data on endovascular thrombectomy (EVT) for acute vertebrobasilar artery occlusion (VBAO) in young adults are limited. We compared clinical characteristics and outcomes after EVT between young and older patients.

Methods: Using a multicenter retrospective registry, we analyzed patients undergoing EVT for acute VBAO. Patients were dichotomized by age (18-44 years vs ≥ 45 years). Primary outcomes were functional independence (modified Rankin Scale score, mRS 0-2) at 90 days and 1 year. Secondary outcomes included successful reperfusion, 24-hour/discharge National Institute of Health Stroke Scale (NIHSS) scores, early neurological function changes, 90-day/1-year mRS distributions, symptomatic intracranial hemorrhage (sICH), and mortality. Multivariable logistic regression adjusted for confounders assessed associations. Interaction effects between age group and hypertension/diabetes/atrial fibrillation were evaluated.

Results: Among 518 patients, 37 (7.1%) were aged 18-44 years. Young patients had fewer cardiovascular comorbidities. Etiologies were more heterogeneous in young patients (large-artery atherosclerosis: 35.1%, other determined cause: 35.1%). Young patients more frequently achieved early neurological improvement and functional independence at 90 days and 1 year (unadjusted). Adjusted analyses showed age dichotomization was not significantly associated with 90-day (aOR 1.15, 95% CI 0.50-2.64, p = 0.74) or 1-year (aOR 1.59, 95% CI 0.68-3.72, p = 0.286) functional independence. A significant hypertension-by-age interaction existed for 90-day functional independence (p = 0.014), and no significant interactions were found for other comorbidities or at 1 year. Mortality and sICH rates were comparable between the two groups.

Conclusions: EVT demonstrates comparable efficacy in young and older VBAO patients, underscoring its critical value especially for young patients with more heterogeneous etiologies.

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来源期刊

Neurological Research 医学-临床神经学

CiteScore

3.60

自引率

0.00%

发文量

116

审稿时长

5.3 months

期刊介绍： Neurological Research is an international, peer-reviewed journal for reporting both basic and clinical research in the fields of neurosurgery, neurology, neuroengineering and neurosciences. It provides a medium for those who recognize the wider implications of their work and who wish to be informed of the relevant experience of others in related and more distant fields. The scope of the journal includes: •Stem cell applications •Molecular neuroscience •Neuropharmacology •Neuroradiology •Neurochemistry •Biomathematical models •Endovascular neurosurgery •Innovation in neurosurgery.