急性中重症基底动脉闭塞患者血管内治疗预后分析

Analysis on prognosis of endovascular treatment in moderate and severe patients with acute basilar artery occlusion

目的探讨急性中重症基底动脉闭塞(BAO)患者血管内治疗的安全性及有效性。方法回顾性分析行血管内治疗的28例急性BAO昏迷患者的临床资料,按术前症状分为中等症状组(昏迷不合并四肢瘫) 17例及重症组(昏迷合并四肢瘫) 11例,统计患者一般情况、术前状态、治疗方式、血管成功再通率、术后脑实质出血发生率及术后3个月改良Rankin量表(mRS)分级。结果 28例患者中20例(71. 4%)为单纯栓塞性闭塞,行支架取栓治疗,8例(28. 6%)为粥样硬化性狭窄继发闭塞,2例导管通过后血管再通,6例支架取栓后行球囊扩张成形及补救支架植入;28例患者中,成功开通血管26例(92. 9%),中等症状组及重症组各有1例开通失败(2例患者均死亡);中等症状组及重症组各有1例发生术后脑实质出血(2例患者均死亡);术后3个月中等症状组预后良好(mRS分级0~2级) 6例(35. 3%),重症组无1例预后良好;中等症状组3例(17. 6%)死亡,重症组6例(54. 5%)死亡。结论昏迷不合并四肢瘫的急性BAO患者行血管内治疗安全有效,昏迷合并四肢瘫BAO患者行血管内治疗不能改善术后3个月的预后。

Objective To investigate the safety and efficacy of endovascular therapy for moderate and severe patients with acute basilar artery occlusion(BAO).Methods The data of 28 coma patients with acute BAO treated by endovascular therapy was retrospectively analyzed.According to preoperative symptoms,17 coma cases without tetraplegia were selected as moderate group and11 coma cases with tetraplegia were selected as severe group.The baseline data,preoperative status,treatment methods,successful recanalization rate,occurrence of hemorrhage of brain parenchyma,and modified Rankin scale(mRS)grading after 3 month were recorded.Results Out of the 28 patients,20(71.4%)presented as simple embolistic occlusion,and were treated by stent embolism removal,8(28.6%)as intracranial atherosclerosis-related occlusions,among whom 2(7.1%)were recanalized after the passing of catheter,and the other 6(21.4%)were treated with balloon dilatation or stent implantation after stent thrombectomy.Twenty-six patients(92.9%)obtained successful revascularization,there was one case failed to get revascularization in moderate group and severe group,and both patients were dead.At the same time,there was one patient with parenchymal hemorrhage after operation in each group,and the two patients were dead.At 3-month followed-up,6 patients(35.3%)presented as good prognosis in the moderate group(mRS classification ranging from 0 to 2 grading),and none with good prognosis occurred in the severe group.There were 3 deaths(17.6%)in moderate group and 6(54.5%)in severe group.Conclusion Endovascular therapy is safe and effective for coma patients without tetraplegia caused by acute BAO.But it can’t improve the 3-month prognosis for coma patients with tetraplegia.