血管内机械取栓治疗急性基底动脉闭塞的有效性和安全性研究

Efficacy and safety of endovascular mechanical thrombectomy for acute basilar artery occlusions

目的评估急性基底动脉闭塞患者行血管内机械取栓治疗的有效性和安全性，并初步分析其基线临床特征与预后的关联。方法回顾性收集自2016年2月至2017年3月在浙江省人民医院神经内科行血管内机械取栓治疗的27例急性基底动脉闭塞患者的临床资料，评估患者的血管再通情况、手术并发症及临床预后，并采用统计学方法分析不同预后患者间基线临床特征的差异。结果27例患者中24例（88．9％）血管成功再通，发病至再通时间平均为（418．92±223．96）min；2例（7．4％）发生症状性颅内出血；发病后3个月随访时14例患者预后良好[改良Rankin量表（mRS）评分0～2分]，13例患者预后不良（mRS评分3-6分），其中8例（29．6％）患者死亡。统计分析显示，预后良好组与预后不良组间基线美国国立卫生研究院卒中量表（Nmss）评分[23（12．5，33．8）分 vs.35（23，39）分]、后循环Alberta卒中项目早期CT评分（pc-ASPECTS）评分[9（8，10）分 vs.7（4，9）分]比较差异均有统计学意义（Z=2．043，P=0．041；Z=-2．387，P=0．017）。结论血管内机械取栓治疗急性基底动脉闭塞具有较高的血管再通率及安全性，患者发病时神经功能缺损程度及侧支循环代偿情况与临床预后有一定关联。

Objective To evaluate the efficacy and safety of endovascular thrombectomy for acute ischemic stroke due to basilar artery occlusion, and analyze the correlation between baseline clinical features and prognoses. Methods The clinical data of 27 patients with acute stroke due to basilar artery occlusion, admitted to and underwent emergency endovascular thrombectomy in our hospital from February 2016 to March 2017, were analyzed retrospectively. The re-canalization rate and complications were determined and the clinical outcomes were assessed. The correlation between clinical features and prognoses were analyzed. Results Successful re-canalization was achieved in 24 out of 27 patients （88.9 %）, and the mean time from onset to re-canalization was （418.92±223.96） min. Symptomatic intracerebral hemorrhage （SICH） was observed in 2 patients （7.4 %） and mortality in the first 3 months was 29.6% （8/27）. At 3-month follow up, 14 patients （51.8 %） showed good prognosis （modified Rankin scale [mRS] scores≤2） and 13 had poor prognosis. Baseline NIHSS scores （23112.5, 33.8] vs. 35[23, 39]） and posterior circulation-Alberta Stroke Program Early CT Scale scores （9 [8, 10] vs. 7 [4, 9]） between patients with good prognosis and poor prognosis were significantly different （Z=-2.043, P=0.041; Z=-2.387,P=0.017）. Conclusions Endovascular thrombectomy can contribute to a high re-canalization rate and safety. Baseline clinical severity and collateral circulation compensation are associated with clinical prognosis.