急性基底动脉闭塞血管内介入治疗的疗效及预后不良的危险因素

目的探讨急性基底动脉闭塞(ABAO)血管内介入治疗(EVT)的疗效及预后不良的危险因素。方法回顾性分析2012年7月至2015年7月收治的172例ABAO的临床资料。102例先采用重组组织型纤溶酶原激活剂动脉内容栓治疗,其中89例溶栓失败再行Solitaire TM支架取栓术治疗;70例直接采用Solitaire TM支架取栓术治疗。结果 172例EVT后,153例获得满意前向血流,血管再通成功率为88.95%;病死率为11.05%。术后90 d,98例预后良好(改良Rankin量表评分0~2分),74例预后不良(改良Rankin量表评分3~6分)。多因素Logistic回归分析显示术前美国国立卫生研究院卒中量表评分≥20分、术前后循环Alberta卒中项目早期CT评分<7分、美国介入和治疗神经放射学学会/介入放射学学会评分0~1级血流及血管未再通是EVT后预后不良的独立危险因素。结论 EVT治疗ABAO疗效确切,影响预后不良的危险因素很多,应采取针对性措施,以改善病人预后。

Effects of endovascular treatment on acute basilar arteries occlusions and analysis of risk factors related to poor prognosis

Objective To analyze the effects of endovascular treatment (EVT) on the patients with acute basilar arteries occlusions (ABAO) and the risk factors related to the poor prognosis. Methods The clinical data of 172 patients with ABAO undergoing EVT from July, 2012 to July, 2017 were analyzed retrospectively. The factors related the poor prognosis were analyzed by univariate and multivariate logistic analysis in 172 patients with ABTO. Results The successful rate of recanalization of occluded basilar arteries was 88.95% and the mortality was 11.05% in 172 patients with ABAO. Of 172 patients with ABAO, 98 had good prognosis and 74, including dead 19 patients, poor prognosis according to modified Rankin scale 90 days after EVT. The independent risk factors related to the poor prognosis included high preoperative National Institutes of Health Stroke Scale (NIHSS) scores, low preoperative posterior circulation Alberta stroke program early CT score (pc-ASPECT), low American Society of Interventional & Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score and poor vascular recanalization in the patients with ABAO undergoing EVT. Conclusions The effects of EVT on ABAO is good. The high preoperative NIHSS score, low PC-ASPECTS score, low ASINN/SIR score and poor revascularization are independent risk factors related to the poor prognosis in the patients with ABAO after EVT.