急性后循环大血管闭塞性脑卒中血管内治疗疗效与安全性的真实世界多中心回顾性研究

耿皓东; 后显华; 陈康宁

doi:10.16016/j.1000-5404.202012132

您当前的位置：

首页 >

文章列表页 >

急性后循环大血管闭塞性脑卒中血管内治疗疗效与安全性的真实世界多中心回顾性研究

临床医学 | 更新时间：2026-01-09

- 急性后循环大血管闭塞性脑卒中血管内治疗疗效与安全性的真实世界多中心回顾性研究
- Efficacy and safety of endovascular therapy for acute stroke due to posterior circulation large vessel occlusion: a real-world multicenter retrospective study
- 第三军医大学学报 2021年43卷第6期页码：534-540
- 作者机构：
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202012132
  中图分类号：
- 收稿：2020-12-15，
  
  纸质出版：2021-03-30
- 稿件说明：
移动端阅览
耿皓东, 后显华, 陈康宁. 急性后循环大血管闭塞性脑卒中血管内治疗疗效与安全性的真实世界多中心回顾性研究[J]. 第三军医大学学报, 2021,43(6):534-540.

Haodong GENG, Xianhua HOU, Kangning CHEN. Efficacy and safety of endovascular therapy for acute stroke due to posterior circulation large vessel occlusion: a real-world multicenter retrospective study[J]. Journal of Third Military Medical University, 2021, 43(6): 534-540.
耿皓东, 后显华, 陈康宁. 急性后循环大血管闭塞性脑卒中血管内治疗疗效与安全性的真实世界多中心回顾性研究[J]. 第三军医大学学报, 2021,43(6):534-540. DOI： 10.16016/j.1000-5404.202012132.

Haodong GENG, Xianhua HOU, Kangning CHEN. Efficacy and safety of endovascular therapy for acute stroke due to posterior circulation large vessel occlusion: a real-world multicenter retrospective study[J]. Journal of Third Military Medical University, 2021, 43(6): 534-540. DOI： 10.16016/j.1000-5404.202012132.

摘要

Abstract

Objective

To evaluate the efficacy and safety of endovascular treatment for acute ischemic stroke caused by large vessel occlusion of posterior circulation in the real world.

Methods

The baseline and clinical data of stroke patients with posterior circulation occlusion who received emergency endovascular treatment (EVT) at 9 stroke centers in the Southwest China from January 2018 to August 2020 were collected and retrospectively analyzed. The main observation indicators included modified Rankin Scale (mRS) score at 90 d

postoperative modified Thrombolysis in Cerebral Infarction (mTICI) score

symptomatic intracranial hemorrhage (sICH)

etc. The enrolled patients were divided into good prognosis group (mRS ≤2) and poor prognosis group (mRS >2) according to their mRS score in 90 d postoperatively. Student's t test and Chi-square analysis were employed to compare the differences in baseline and clinical data between the 2 groups

and the results were further analyzed in subgroups.

Results

A total of 108 patients were enrolled in this study. In 90 d after treatment

the ratio of good prognosis was 43.5% (47/108)

mortality rate 25.9% (28/108)

vessel recanalization rate 95.4% (103/108)

and sICH rate 8.3% (9/108). There were significan

t differences between the 2 groups in preoperative Posterior circulation Alberta Stroke Program Early CT Score (Pc-ASPECTS)

National Institutes of Health Stroke Scale (NIHSS) score

Glasgow Coma Scale (GCS) score

Basilar Artery on Computed Tomography Angiography (BATMAN) score

vessel recanalization rate and sICH rate (

0.05). The results of subgroup analysis suggested that the patients with a shorter recanalization time had a higher rate of good prognosis (

0.05)

and those with good recanalization had lower mortality rate (

0.05).

Conclusion

In the real world

endovascular treatment for large-vessel occlusive stroke in the posterior circulation is safe and effective. Rapid recanalization of occlusive vessels is beneficial to improve the clinical prognosis and reduce mortality.

关键词

Keywords

references

BANERJEE G STONE S P WERRING D J Posterior circulation ischaemic stroke BMJ Clin Res Ed 2018 361 k1185 10.1136/bmj.k1185 BANERJEE G, STONE S P, WERRING D J. Posterior circulation ischaemic stroke[J]. BMJ Clin Res Ed, 2018, 361: k1185. DOI: 10.1136/bmj.k1185.

SCHONEWILLE W J ALGRA A SERENA J Outcome in patients with basilar artery occlusion treated conventionally J Neurol Neurosurg Psychiatry 2005 76 9 1238 1241 10.1136/jnnp.2004.049924 SCHONEWILLE W J, ALGRA A, SERENA J, et al . Outcome in patients with basilar artery occlusion treated conventionally[J ] . J Neurol Neurosurg Psychiatry, 2005, 76(9): 1238-1241. DOI: 10.1136/jnnp.2004.049924 .

WEN W L LI Z F ZHANG Y W Effect of baseline characteristics on the outcome of stent retriever-based thrombectomy in acute basilar artery occlusions: a single-center experience and pooled data analysis World Neurosurg 2017 104 1 8 10.1016/j.wneu.2017.04.015 WEN W L, LI Z F, ZHANG Y W, et al . Effect of baseline characteristics on the outcome of stent retriever-based thrombectomy in acute basilar artery occlusions: a single-center experience and pooled data analysis[J ] . World Neurosurg, 2017, 104: 1-8. DOI: 10.1016/j.wneu.2017.04.015.

GOYAL M MENON B K VAN ZWAM W H Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials Lancet 2016 387 10029 1723 1731 10.1016/S0140-6736(16)00163-X GOYAL M, MENON B K, VAN ZWAM W H, et al . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analys is of individual patient data from five randomised trials[J ] . Lancet, 2016, 387(10029): 1723-1731. DOI: 10.1016/S0140-6736(16)00163-X.

Writing Group For The Basilar Group Zi W J Qiu Z M Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry JAMA Neurol 2020 77 5 561 573 10.1001/jamaneurol.2020.0156 Writing Group For The Basilar Group, Zi W J, Qiu Z M, et al . Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry[J ] . JAMA Neurol, 2020, 77(5): 561-573. DOI: 10.1001/jamaneurol.2020.0156.

热孜亚·阿布都许库尔吕珊贺耀德急性缺血性卒中血管再通治疗研究历程协和医学杂志 2020 11 2 162 169 10.3969/j.issn.1674-9081.20190273 热孜亚·阿布都许库尔, 吕珊, 贺耀德, 等. 急性缺血性卒中血管再通治疗研究历程[J]. 协和医学杂志, 2020, 11(2): 162-169. DOI: 10. 3969/j.issn.1674-9081.20190273.

ABUDUXUKUER R LYU S HE Y D Rearch course of reperfusion therapy for acute ischemic stroke Med J PUMCH 2020 11 2 162 169 10.3969/j.issn.1674-9081.20190273 ABUDUXUKUER R, LYU S, HE Y D, et al . Rearch course of reperfusion therapy for acute ischemic stroke[J ] . Med J PUMCH, 2020, 11(2): 162-169. DOI: 10. 3969/j.issn.1674-9081.20190273.

罗岗黄祎诺莫大鹏后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究中国卒中杂志 2019 14 4 309 316 10.3969/j.issn.1673-5765.2019.04.003 罗岗, 黄祎诺, 莫大鹏, 等. 后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究[J]. 中国卒中杂志, 2019, 14(4): 309-316. DOI: 10.3969/j.issn.1673-5765.2019.04.003.

LUO G HAUNG W N MO D P Mechanical Thrombectomy versus Intravenous Thrombolysis for Acute Posterior Circulation Stroke Chin J Stroke 2019 14 4 309 316 10.3969/j.issn.1673-5765.2019.04.003 LUO G, HAUNG W N, MO D P, et al . Mechanical Thrombectomy versus Intravenous Thrombolysis for Acute Posterior Circulation Stroke[J ] . Chin J Stroke, 2019, 14(4): 309-316. DOI: 10.3969/j.issn.1673-5765.2019.04.003.

SANG H F YIN C G XIA W Q Mechanical thrombectomy using solitaire in acute ischemic stroke patients with vertebrobasilar occlusion: a prospective observational study World Neurosurg 2019 128 e355 e361 10.1016/j.wneu.2019.04.152 SANG H F, YIN C G, XIA W Q, et al . Mechanical thrombectomy using solitaire in acute ischemic stroke patients with vertebrobasilar occlusion: a prospective observational study[J ] . World Neurosurg, 2019, 128: e355-e361. DOI: 10.1016/j.wneu.2019.04.152.

RENTZOS A KARLSSON J E LUNDQVIST C Endovascular treatment of acute ischemic stroke in the posterior circulation Interv Neuroradiol 2018 24 4 405 411 10.1177/1591019918762320 RENTZOS A, KARLSSON J E, LUNDQVIST C, et al . Endovascular treatment of acute ischemic stroke in the posterior circulation[J ] . Interv Neuroradiol, 2018, 24(4): 405-411. DOI: 10.1177/1591019918762320.

LI C ZHAO W WU C Outcome of endovascular treatment for acute basilar artery occlusion in the modern era: a single institution experience Neuroradiology 2018 60 6 651 659 10.1007/s00234-018-2011-7 LI C, ZHAO W, WU C, et al . Outcome of endovascular treatment for acute basilar artery occlusion in the modern era: a single institution experience[J ] . Neuroradiology, 2018, 60(6): 651-659. DOI: 10.1007/s00234-018-2011-7.

LEE H N KIM B T IM S B Implications of mechanical endovascular thrombectomy for acute basilar and posterior cerebral artery occlusion J Cerebrovasc Endovasc Neurosurg 2018 20 3 168 175 10.7461/jcen.2018.20.3.168 LEE H N, KIM B T, IM S B, et al . Implications of mechanical endovascular thrombectomy for acute basilar and posterior cerebral artery occlusion[J ] . J Cerebrovasc Endovasc Neurosurg, 2018, 20(3): 168-175. DOI: 10.7461/jcen.2018.20.3.168.

BATH P M LEES K R SCHELLINGER P D Statistical analysis of the primary outcome in acute stroke trials Stroke 2012 43 4 1171 1178 10.1161/strokeaha.111.641456 BATH P M, LEES K R, SCHELLINGER P D, et al . Statistical analysis of the primary outcome in acute stroke trials[J ] . Stroke, 2012, 43(4): 1171-1178. DOI: 10.1161/strokeaha.111.641456.

MARKS M P LANSBERG M G MLYNASH M Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome J Neurointerv Surg 2014 6 10 724 728 10.1136/neurintsurg-2013-010973 MARKS M P, LANSBERG M G, MLYNASH M, et al . Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome[J ] . J Neurointerv Surg, 2014, 6(10): 724-728. DOI: 10.1136/neurintsurg-2013-010973.

HACKE W KASTE M FIESCHI C Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS Ⅱ). Second European-Australasian Acute Stroke Study Investigators Lancet 1998 352 9136 1245 1251 10.1016/s0140-6736(98)08020-9 HACKE W, KASTE M, FIESCHI C, et al . Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS Ⅱ). Second European-Australasian Acute Stroke Study Investigators[J ] . Lancet, 1998, 352(9136): 1245-1251. DOI: 10.1016/s0140-6736(98)08020-9.

SCHONEWILLE W J WIJMAN C A MICHEL P Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study Lancet Neurol 2009 8 8 724 730 10.1016/s1474-4422(09)70173-5 SCHONEWILLE W J, WIJMAN C A, MICHEL P, et al . Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study[J ] . Lancet Neurol, 2009, 8(8): 724-730. DOI: 10.1016/s1474-4422(09)70173-5.

LIU X F DAI Q YE R Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial Lancet Neurol 2019 19 2 115 122 10.1016/s1474-4422(19)30395-3 LIU X F, DAI Q, YE R, et al . Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial[J ] . Lancet Neurol, 2019, 19(2): 115-122. DOI: 10.1016/s1474-4422(19)30395-3.

GRAPOW M T VON WATTENWYL R GULLER U Randomized controlled trials do not reflect reality: real-world analyses are critical for treatment guidelines! J Thorac Cardiovasc Surg 2006 132 1 5 7 10.1016/j.jtcvs.2006.03.035 GRAPOW M T, VON WATTENWYL R, GULLER U, et al . Randomized controlled trials do not reflect reality: real-world analyses are critical for treatment guidelines![J ] . J Thorac Cardiovasc Surg, 2006, 132(1): 5-7. DOI: 10.1016/j.jtcvs.2006.03.035.

KUMAR G SHAHRIPOUR R B ALEXANDROV A V Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis J Neurointerv Surg 2015 7 12 868 874 10.1136/neurintsurg-2014-011418 KUMAR G, SHAHRIPOUR R B, ALEXANDROV A V. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis[J]. J Neurointerv Surg, 2015, 7(12): 868-874. DOI: 10.1136/neurintsurg-2014-011418.

PASARIKOVSKI C R KHOSRAVANI H DA COSTA L Outcomes of endovascular thrombectomy for basilar artery occlusion Can J Neurol Sci 2020 47 4 479 485 10.1017/cjn.2020.51 PASARIKOVSKI C R, KHOSRAVANI H, DA COSTA L, et al . Outcomes of endovascular thrombectomy for basilar artery occlusion[J ] . Can J Neurol Sci, 2020, 47(4): 479-485. DOI: 10.1017/cjn.2020.51.

DEGUCHI I OSADA T KIMURA H Clinical outcomes of mechanical thrombectomy following intravenous administration of recombinant tissue-type plasminogen activator for basilar artery occlusion Clin Neurol Neurosurg 2020 194 105796 10.1016/j.clineuro.2020.105796 DEGUCHI I, OSADA T, KIMURA H, et al . Clinical outcomes of mechanical thrombectomy following intravenous administration of recombinant tissue-type plasminogen activator for basilar artery occlusion[J ] . Clin Neurol Neurosurg, 2020, 194: 105796. DOI: 10.1016/j.clineuro.2020.105796.

LUO G MO D TONG X Factors associated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy World Neurosurg 2018 109 e318 e328 10.1016/j.wneu.2017.09.171 LUO G, MO D, TONG X, et al . Factors associated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy[J ] . World Neurosurg, 2018, 109: e318-e328. DOI: 10.1016/j.wneu.2017.09.171.

TEI H UCHIYAMA S USUI T Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome J Neurol 2010 257 5 767 773 10.1007/s00415-009-5406-x TEI H, UCHIYAMA S, USUI T, et al . Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome[J ] . J Neurol, 2010, 257(5): 767-773. DOI: 10.1007/s00415-009-5406-x.

YANG H MA N LIU L The basilar artery on computed tomography angiography score for acute basilar artery occlusion treated with mechanical thrombectomy J Stroke Cerebrovasc Dis 2018 27 6 1570 1574 10.1016/j.jstrokecerebrovasdis.2018.01.007 YANG H, MA N, LIU L, et al . The basilar artery on computed tomography angiography score for acute basilar artery occlusion treated with mechanical thrombectomy[J ] . J Stroke Cerebrovasc Dis, 2018, 27(6): 1570-1574. DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.007.

VALENTINO F GENTILE L TERRUSO V Frequency and determinants for hemorrhagic transformation of posterior cerebral stroke: Posterior ischemic stroke and hemorrhagic transformation BMC Res Notes 2017 10 1 592 10.1186/s13104-017-2889-x VALENTINO F, GENTILE L, TERRUSO V, et al . Frequency and determinants for hemorrhagic transformation of posterior cerebral stroke: Posterior ischemic stroke and hemorrhagic transformation[J ] . BMC Res Notes, 2017, 10(1): 592. DOI: 10.1186/s13104-017-2889-x.

NEUBERGER U SEKER F SCHÖNENBERGER S Prediction of intracranial hemorrhages after mechanical thrombectomy of basilar artery occlusion J Neurointerventional Surg 2019 11 12 1181 1186 10.1136/neurintsurg-2019-014939 NEUBERGER U, SEKER F, SCHÖNENBERGER S, et al . Prediction of intracranial hemorrhages after mechanical thrombectomy of basilar artery occlusion[J ] . J Neurointerventional Surg, 2019, 11(12): 1181-1186. DOI: 10.1136/neurintsurg-2019-014939.

JUNG S GILGEN M SLOTBOOM J Factors that determine penumbral tissue loss in acute ischaemic stroke Brain 2013 136 pt 12 3554 3560 10.1093/brain/awt246 JUNG S, GILGEN M, SLOTBOOM J, et al . Factors that determine penumbral tissue loss in acute ischaemic stroke[J ] . Brain, 2013, 136(pt 12): 3554-3560. DOI: 10.1093/brain/awt246.

VERGOUWEN M D I ALGRA A PFEFFERKORN T Time is brain(stem) in basilar artery occlusion Stroke 2012 43 11 3003 3006 10.1161/STROKEAHA.112.666867 VERGOUWEN M D I, ALGRA A, PFEFFERKORN T, et al . Time is brain(stem) in basilar artery occlusion[J ] . Stroke, 2012, 43(11): 3003-3006. DOI: 10.1161/STROKEAHA.112.666867.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

急性前循环大血管闭塞性卒中患者血管内治疗后发生卒中相关性肺炎的危险因素分析

大核心梗死的急性缺血性卒中血管内治疗疗效观察与影响因素分析

急性缺血性卒中血管内治疗后实质性出血2型颅内出血的影响因素分析