不同病理机制急性椎基底动脉闭塞患者临床特征及血管内治疗效果比较

Comparison of Clinical Characteristics and Endovascular Treatment Effects in Patients with Acute Vertebrobasilar Artery Occlusion of Different Pathological Mechanisms

目的比较颅内动脉粥样硬化疾病(ICAD)和栓塞两种病理机制导致的急性椎基底动脉闭塞(AVBO)患者临床特征及血管内治疗效果。方法选取2019年1月至2021年11月在南阳市中心医院接受血管内治疗的116例AVBO患者,根据病理机制将其分为ICAD组72例和栓塞组44例。收集并比较患者术前资料(包括一般资料、临床资料)、术中血管造影检查结果〔闭塞位置、急性基底动脉闭塞侧支循环血管造影评分(ACGS-BAO)〕、术后即刻血管再通成功情况、围术期症状性颅内出血发生率和预后情况。结果两组患者性别、年龄和有高血压史、糖尿病史、心房颤动史、卒中史、吸烟史者占比及美国国立卫生研究院卒中量表(NIHSS)评分、后循环Alberta卒中项目早期CT评分(ASPECTS)、基底动脉计算机扫描血管造影评分(BATMAN)、静脉溶栓率、发病至入院时间比较,差异无统计学意义(P>0.05);ICAD组患者格拉斯哥昏迷量表(GCS)评分低于栓塞组(P<0.05)。两组患者血管闭塞位置比较,差异有统计学意义(P<0.05);ICAD组闭塞部位常见于椎动脉V4段、基底动脉中段,栓塞组闭塞部位常见于基底动脉上段。ICAD组患者ACGS-BAO高于栓塞组(P<0.05);两组患者术后即刻血管再通成功率、围术期症状性颅内出血发生率、预后良好率比较,差异无统计学意义(P>0.05)。结论ICAD可能是AVBO患者更常见的病理机制,病理机制为ICAD的AVBO患者术前GCS评分可能低于病理机制为栓塞者,且前者的闭塞位置常见于椎动脉V4段、基底动脉中段,后者的闭塞位置常见于基底动脉上段。两种不同病理机制的AVBO患者经血管内治疗后血管再通成功率和预后良好率相当。

Objective To compare the clinical characteristics and endovascular treatment effects of patients with acute vertebrobasilar occlusion(AVBO)caused by intracranial atherosclerotic disease(ICAD)and embolization.Methods A total of 116 patients with AVBO who received endovascular treatment in Nanyang Central Hospital from January 2019 to November 2021 were selected and divided into ICAD group(72 cases)and embolization group(44 cases)according to the pathological mechanism.Patients'preoperative data(including general data and clinical data),intraoperative angiographiy results[occlusion location,angiographic collateral grading system for basilar artery occlusion(ACGS-BAO)]and immediate postoperative recanalization success,incidence of perioperative symptomatic intracranial hemorrhage,and prognosis were collected and compared.Results There was no significant difference in gender,age,the proportion of patients with history of hypertension,diabetes,atrial fibrillation,stroke and smoking,National Institutes of Health Stroke Scale(NIHSS)score,Alberta Stroke Program Early CT Score(ASPECTS),basilar artery on computed tomography angiography score(BATMAN),intravenous thrombolysis rate,and time from onset to admission between the two groups(P>0.05).The Glasgow Coma Scale(GCS)score in the ICAD group was lower than that in the embolization group(P<0.05).There was a statistically significant difference in the location of vascular occlusion between the two groups(P<0.05).The occlusion sites in the ICAD group were more common in the V4 segment of the vertebral artery and the middle segment of the basilar artery,and the occlusion sites in the embolization group were more common in the upper segment of the basilar artery.The ACGS-BAO of the patients in the ICAD group was higher than that in the embolization group(P<0.05).There was no significant difference in the immediate postoperative recanalization success rate,the incidence of perioperative symptomatic intracranial hemorrhage,and the good prognosis rate between the two groups(P>0.05).Conclusion ICAD may be a more common pathological mechanism in AVBO patients.The preoperative GCS score of AVBO patients with pathological mechanism of ICAD may be lower than that of patients with pathological mechanism of embolism,and the occlusion location of the former is more common in the V4 segment of the vertebral artery and the middle segment of the basilar artery,and the occlusion location of the latter is more common in the upper basilar artery.The success rate of recanalization and good prognosis of AVBO patients with two different pathological mechanisms are similar after endovascular therapy.