DSA评估基础下基底动脉闭塞预后影响因素及治疗策略分析

Analysis of prognostic factors and treatment strategies for basilar artery occlusion based on DSA assessmen

目的 探讨数字减影血管造影术(DSA)评估基础下基底动脉闭塞(BAO)患者再发脑梗死的影响因素,为预后差患者的下一步介入治疗提供依据。方法 回顾性分析随访1年42例基底动脉闭塞患者的临床资料,患者病情稳定后进行DSA检查及影像学评估。采用单因素及多因素Logistic回归分析基底动脉闭塞再发脑梗死的影响因素。结果 42例患者中,全脑血管造影评估后随访1年内再发脑梗死10例(核磁DWI证实),未再发脑梗死32例。单因素分析显示:再发脑梗死患者年龄、侧支代偿2级占比、住院次数≥2次占比均高于未再发脑梗死患者,差异均有统计学意义(P<0.05)。Logistic回归分析显示,侧支代偿是基底动脉闭塞患者再发脑梗死的独立影响因素(OR=9.747, P<0.05)。结论 年龄、侧支代偿、住院次数是影响再发脑梗死的因素,其中侧支代偿是独立影响因素,在评估好风险情况下血管内治疗是减少再发脑梗死的一种潜在办法。

Objective To discuss the influencing factors of recurrent cerebral infarction in patients with basilar artery occlusion(BAO)based on digital subtraction angiography(DSA)assessment,and provide a basis for the next interventional treatment of patients with poor prognosis.Methods The clinical data of 42 patients with basilar artery occlusion at 1 year of follow-up were retrospectively analyzed,and DSA examination and imaging evaluation were performed after the patients in stable condition.Factors influencing the recurrent cerebral infarction of basilar artery occlusion were analyzed by univariate analysis and multifactorial Logistic regression.Results Of the 42 patients,10 cases had recurrent cerebral infarction(confirmed by magnetic resonance DWI)within 1 year of follow-up after whole cerebral angiography assessment and 32 cases had no recurrent cerebral infarction.Univariate analysis showed that the age,percentage of collateral compensation grade 2,and percentage of hospitalizations≥2 times were higher in patients with recurrent cerebral infarction than those in patients without recurrent cerebral infarction,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that collateral compensation was an independent factor influencing recurrent cerebral infarction in patients with basilar artery occlusion(OR=9.747,P<0.05).Conclusion Age,collateral compensation,and the number of hospitalizations are factors that affect recurrence of cerebral infarction,with collateral compensation being an independent influence.Endovascular treatment with good risk assessment is a potential way to reduce recurrent cerebral infarction.