不同基底动脉弯曲度对急性基底动脉闭塞患者取栓治疗的影响

Influence of different basilar artery bending length on the mechanical thrombectomy of patients with acute basilar artery occlusion

目的探讨不同基底动脉弯曲度(BL)对急性基底动脉闭塞(ABAO)患者取栓治疗的影响。方法回顾性分析盱眙县人民医院神经内科及江苏省人民医院介入放射科自2018年1月至2021年12月收治的110例ABAO患者的临床及影像资料。根据DSA图像上基底动脉的BL,将110例患者分为非重度弯曲组(0~2级,60例)和重度弯曲组(3级,50例)。比较2组患者的基线资料、取栓治疗及预后情况,分析基底动脉重度弯曲对取栓治疗的影响。结果2组患者中男性、高血压、高脂血症、术中使用中间导管、大动脉粥样硬化型、心源性栓塞、基底动脉下段闭塞、取栓结合血管成形术占比及基线美国国立卫生研究院卒中量表评分、再通成功(mTICI 2b~3级)率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,基底动脉BL(OR=1.315,95%CI:1.017~1.700,P=0.037)、取栓次数(OR=3.167,95%CI:1.626~6.168,P=0.001)是ABAO取栓治疗再通失败的独立危险因素。结论基底动脉重度弯曲对ABAO取栓治疗的症状性颅内出血、病死率、90 d良好预后无影响,但可能导致ABAO取栓治疗再通失败。

Objective To investigate the impacts of different basilar artery bending length(BL)on mechanical thrombectomy of patients with acute basilar artery occlusion(ABAO).Methods The clinical and imaging data of 110 ABAO patients admitted to the Neurology Department of Xuyi County People's Hospital and the Interventional Radiology Department of Jiangsu Provincial People's Hospital from January 2018 to December 2021 were retrospectively analyzed.According to the BL of basilar artery,patients were divided into non-severe basilar artery tortuosity group(60 cases)and severe basilar artery tortuosity group(50 cases).BL of basilar artery was analyzed on DSA.The baseline data,mechanical thrombectomy and prognosis of 2 groups were compared to analyze the influence of severe basilar artery tortuosity on mechanical thrombectomy.Results There were significant differences among male,hypertension,hyperlipidemia,use of intermediate catheters,large artery atherosclerosis,cardiac embolism,basal artery occlusion of lower segment,combined with angioplasty,baseline National Institute of Health stroke scale score,and recanalization rate between the non-severe basilar artery tortuosity group and the severe basilar artery tortuosity group(P<0.05).Multivariate Logistic regression analysis of risk factors for basilar artery recanalization failure showed that:basilar artery tortuosity(OR=1.315,95%CI:1.017-1.700,P=0.037)and times of thrombectomy(OR=3.167,95%CI:1.626-6.168,P=0.001)were independent risk factors for recanalization failure of mechanical thrombectomy.Conclusion Severe basilar artery tortuosity is not correlated with symptomatic intracranial hemorrhage,mortality rate and the modified Rankin scale score at 90 d in patients with ABAO treated with mechanical thrombectomy,and severe basilar artery tortuosity may lead to recanalization failure.