新型DSA侧支量表用于预测急性基底动脉闭塞血管内治疗后无效再通的单中心研究

目的:探讨新型DSA侧支量表用于预测急性基底动脉闭塞（BAO）血管内治疗（EVT）术后无效再通风险的价值。方法:前瞻性连续收集首都医科大学附属北京天坛医院2012年1月至2018年7月接受EVT的148例急性BAO患者。新型DSA侧支量表基于术前DSA图像评价基底动脉的侧支循环，分为4级，1~2级为侧支代偿差、3级为侧...

A novel DSA-based collateral scale for prediction of futile recanalization in acute basilar artery occlusion: a single-center observational study

Objective To develop a novel collateral scale based on DSA for predicting futile recanalization of acute basilar artery occlusion(BAO)after endovascular therapy(EVT).Methods A prospectively registered consecutive cohort of 148 BAO patients treated with EVT from January 2012 to July 2018 in Beijing Tiantan Hospital Capital Medical University was reviewed.The novel DSA-based collateral scale had 4 grades for poor(Grade 1-2),intermediate(Grade 3)and good(Grade 4)collateral status.Futile recanalization was defined as the occurrence of poor outcome(modified Rankin scale>3)at 90 d despite successful recanalization(modified thrombolysis in cerebral infarction≥2b)after EVT.Interobserver agreement for the proposed collateral scale was assessed by Kappa coefficient.The independent association of the collateral scale with futile recanalization was evaluated by multivariable logistic regression,and the effects of the collateral scale on futile recanalization in different subgroups stratified by age,time window,severity and etiology of stroke were also explored.Results Of 148 patients in this study,69(46.6%)suffered from futile recanalization.There were 3,25,78 and 42 patients with grade 1 to 4 of the novel DSA-based collateral scale,and the incidence of futile recanalization was 100%(3/3),72.0%(18/25),44.4%(37/78)and 26.2%(11/42),respectively,showing a downward trend.Interobserver agreement of the proposed collateral scale was excellent(weighted Kappa=0.95,95%CI 0.91-0.99).A multivariable logistic analysis showed that the collateral scale was significantly associated with futile recanalization(adjusted OR=0.47,95%CI 0.23-0.98).And the effects of the collateral scale on futile recanalization were consistent across all subgroups(P>0.1 for all interactions).Conclusion The novel DSA-based collateral scale may be a valid and reliable predictor of futile recanalization in BAO patients treated with EVT.