背景:在之前的一项研究中,显示基底动脉闭塞(BAO)导致80%的患者死亡或残疾。BAO患者急性期的治疗包括溶栓和动脉内取栓,但并非所有患者都能从这些治疗中受益。因此,在开始这些治疗之前了解结果的预测因素是特别感兴趣的。
目的:确定与亚洲人群BAO患者90天临床结局相关的预测因子。
方法:我们对2015年至2019年三级卒中中心收治的患者进行了回顾性病例回顾。我们使用国际疾病分类-10标准来识别后循环中风的病例。神经科医生检查了每个病例,纳入符合基底动脉国际合作研究标准的患者。然后,我们分析了患者的特征和与90天预后相关的因素。
结果:我们确定了总共99例患者为真正的BAO病例。在这些病人中,33例(33.3%)在90d时预后良好(改良Rankin量表:0-3)。此外,72例患者接受了动脉内血栓切除术,13例患者接受静脉内组织型纤溶酶原激活剂治疗。我们观察到33.3%的病例有有利的结果,66.7%的病例有不利的结果。我们发现,最初的美国国立卫生研究院卒中量表(NIHSS)评分和几个BAO症状,包括意识受损,四肢轻瘫,和瞳孔异常,与不良结局显着相关(P<0.05),而小脑症状与良好的预后相关(P<0.05)。在接收机工作特性(ROC)分析中,初始NIHSS评分的ROC曲线下面积,意识受损,四肢轻瘫,小脑症状,瞳孔异常分别为0.836、0.644、0.727、0.614和0.614。初始NIHSS评分显示与BAO症状相比更高的AUROC(0.836)。
结论:不良结局的最重要预测指标是初始NIHSS评分。BAO症状,包括四肢轻瘫,意识受损,瞳孔异常也与不良结局有关。
BACKGROUND: In a previous study, basilar artery occlusion (BAO) was shown to lead to death or disability in 80% of the patients. The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy, but not all patients benefit from these treatments. Thus, understanding the predictors of outcome before initiating these treatments is of special interest.
OBJECTIVE: To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.
METHODS: We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019. We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke. A neurologist reviewed every case, and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included. We then analyzed the patients\' characteristics and factors related to the 90-d outcome.
RESULTS: We identified a total of 99 patients as real BAO cases. Of these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0-3). Moreover, 72 patients received intra-arterial thrombectomy, while 13 patients received intravenous tissue-type plasminogen activator treatment. We observed a favorable outcome in 33.3% of the cases and an unfavorable outcome in 66.7% of the cases. We found that the initial National Institutes of Health Stroke Scale (NIHSS) score and several BAO symptoms, including impaired consciousness, tetraparesis, and pupillary abnormalities, were significantly associated with an unfavorable outcome (P < 0.05), while cerebellar symptoms were associated with a favorable outcome (P < 0.05). In the receiver operating characteristic (ROC) analysis, the areas under the ROC curve of initial NIHSS score, impaired consciousness, tetraparesis, cerebellar symptoms, and pupillary abnormalities were 0.836, 0.644, 0.727, 0.614, and 0.614, respectively. Initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.
CONCLUSIONS: The most important predictor of an unfavorable outcome was the initial NIHSS score. BAO symptoms, including tetraparesis, impaired consciousness, and pupillary abnormality were also related to an unfavorable outcome.