急性椎基底动脉闭塞不同病变部位血管内开通策略的比较研究

Strategies of endovascular recanalization in acute vertebrobasilar artery occlusion of different lesion sites:a comparative analysis

目的探讨急性椎基底动脉闭塞(AVBAO)不同病变部位发病机制、血管内治疗(EVT)策略选择及疗效的差异。方法选择自2017年2月至2019年9月河南省人民医院脑血管病科收治的105例行EVT的AVBAO患者进入研究,收集患者起病形式、影像学检查结果、EVT情况、围手术期并发症及预后等资料。依据DSA造影结果将病变累及部位分为4部分:基底动脉(BA)上段、BA中段、BA下段及椎动脉颅内段(即V4段),合并串联病变者以远心端病变部位记录。比较4种不同病变部位患者发病危险因素、EVT开通策略及随访90 d时预后[改良Rankin量表(mRS)评分≤3分为预后良好]。结果4组患者合并房颤的比例及病因分型差异有统计学意义(P<0.05)。4组患者接受急诊支架植入的比例差异有统计学意义(P<0.05),其中V4段患者比例最高(79.55%),其次为BA下段(50.00%),差异有统计学意义(P<0.05)。4组患者的手术时间(动脉穿刺到闭塞血管成功再通的时间)差异有统计学意义(P<0.05),其中BA下段患者开通时间最长[115.0(81.0,163.0)min],BA中段最短[87.5(58.8,130.8)min],差异有统计学意义(P<0.05)。治疗后90 d时4组患者预后良好率差异无统计学意义(P>0.05)。结论不同AVBAO病变部位患者发病机制存在差异,宜采取不同的EVT开通策略。

Objective To investigate the pathogenesis,selection of endovascular treatment(EVT)strategies,and efficacies of acute vertebrobasilar artery occlusion(AVBAO)of different lesion sites.Methods One hundred and five patients with AVBAO,admitted to and accepted EVT in our hospital from February 2017 to September 2019,were chosen in our study.The data of disease onset,imaging findings,EVT status,perioperative complications,and prognoses of these patients were collected.According to DSA results,the involved lesions were divided into 4 sites:the upper segment of basilar artery(BA),the middle segment of BA,the lower segment of BA,and the intracranial segment of vertebral artery(V4 segment),and patients with tandem lesions would be recorded as distal lesions.The risk factors,EVT strategies,and prognoses 90 d after follow-up(modified Rankin scale[mRS]scores≤3:good prognosis)were compared in patients with 4 different lesion sites.Results There were significant differences in etiological classifications and percentage of patients combined with atrial fibrillation among patients with 4 different lesion sites(P<0.05).There was significant difference in proportion of patients accepted emergency stent implantation among patients with 4 different lesion sites(P<0.05):those with lesions at the V4 segment had the highest proportion of patients accepted emergency stent implantation(79.55%),followed by those with lesions at the lower segment of BA(50.00%).There was significant difference in EVT time(the time from arterial puncture to successful recanalization of occluded vessels)among patients with 4 different lesion sites(P<0.05):the EVT time in patients with lesions at the middle segment of BA was the shortest(87.5[58.5,130.8]min),and the EVT time in patients with lesions at the lower segment of BA was the longest(115.0[81.0,163.0]min).There was no statistical difference among patients with different lesion sites in good prognosis rate 90 d after follow-up(P>0.05).Conclusion The pathogenesis of patients with different AVBAO lesion sites is different,so different EVT strategies should be adopted.