急性基底动脉闭塞血管内治疗预后的影响因素分析

Analysis of risk factors for prognosis of acute basilar artery occlusion after endovascular treatment

目的研究影响急性基底动脉闭塞(aBAO)血管内治疗预后的因素,并评估各危险因素对预后的预测价值。方法回顾性连续纳入2010年1月至2020年6月就诊于广东省中医院行血管内治疗的aBAO患者的临床和影像资料,包括侧支评分、后循环侧支评分、后循环CT血管成像(pc-CTA)评分、基底动脉CT血管成像(BATMAN)评分。根据术后90 d改良Rankin量表(mRS)评分结果,将所有患者分为预后良好组(35例,mRS评分≤2分)和预后不良组(61例,mRS评分>2分)。采用单因素和多因素Logistic回归分析方法分析影响预后的因素,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)以评估各危险因素对血管内治疗后预后的预测价值。结果共纳入96例行血管内治疗的aBAO患者,35例(36.46%)预后良好,61例(63.54%)预后不良。Logistic回归分析结果显示,入院时高美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.068,95%CI:1.006~1.134)、入院时低格拉斯哥昏迷量表(GCS)评分(OR=0.748,95%CI:0.648~0.864)、高pc-CTA评分(OR=1.616,95%CI:1.212~2.153)、低BATMAN评分(OR=0.717,95%CI:0.578~0.889)是患者血管内治疗术后预后不良的独立危险因素。ROC曲线结果显示,入院时NIHSS、GCS评分和术前pc-CTA、BATMAN评分的曲线下面积分别为0.566(95%CI:0.455~0.686,P=0.285)、0.545(95%CI:0.420~0.663,P=0.467)、0.703(95%CI:0.597~0.809,P=0.001)、0.686(95%CI:0.579~0.793,P=0.003)。结论入院时高NIHSS评分、入院时低GCS评分、高pc-CTA评分、低BATMAN评分是aBAO血管内治疗预后不良的独立危险因素。基于DSA检查结果的BATMAN评分对血管内治疗术后预后可能具有一定的预测价值,仍需多中心大样本的前瞻性随机对照试验加以验证。

Objective To explore risk factors affecting the prognosis of acute basilar artery occlusion(aBAO)patients after endovascular treatment,and assess predictive value of the risk factors on the prognosis.Methods From January 2010 to June 2020,we analyzed clinical and radiological data of aBAO patients admitted in Guangdong Provincial Hospital of Chinese Medicine.Collected data included collateral score,posterior circulation collateral score,posterior circulation computed tomography angiography(pc-CTA)vascular score,basilar artery on CTA(BATMAN)score.According to modified Rankin scale(mRS)scores at 3 months,the patients were divided into favorable outcome group(mRS≤2)and unfavorable outcome group(mRS>2).Univariate and multivariate Logistic regression analysis was used to analyze risk factors affecting the prognosis after endovascular treatment.The receiver operating characteristic curve(ROC)was drawn and the area under curve(AUC)was calculated to evaluate the predictive value of the risk factors.Results A total of 96 aBAO patients receiving endovascular treatment were enrolled in the study.Thirty-five cases(36.46%)achieved favorable outcome and 61 cases(63.54%)had unfavorable outcome.According to the binary stepwise Logistic regression analysis,higher NIHSS score on admission(OR,1.068,95%CI 1.006-1.134),lower GCS score on admission(OR,0.748,95%CI 0.648-0.864),higher pc-CTA score(OR,1.616,95%CI 1.212-2.153),lower BATMAN score(OR,0.717,95%CI 0.578-0.889)were independently associated with unfavorable outcome.According to the ROC analysis,the area under the curve of NIHSS,GCS and BATMAN were respectively 0.566(95%CI 0.445-0.686,P=0.285)、0.545(95%CI 0.426-0.663,P=0.467)and 0.703(95%CI 0.597-0.809,P=0.001)and 0.686(95%CI 0.579-0.793,P=0.003).Conclusions Higher NIHSS score on admission,lower GCS score on admission,and higher pc-CTA score,lower BATMAN score may be independent predictors of unfavorable functional outcome in aBAO patients after endovascular treatment.The BATMAN score based on the DSA may have some predictive value on the functional outcome after endovascular treatment,while need to be tested by multicenter large sample prospective randomized controlled trial.