[1]丁 运,李沛城,陈 珑,等.急性基底动脉闭塞致昏迷及机械清除血栓良好预后的影响因素[J].介入放射学杂志,2025,34(04):355-361.[doi:10.3969/j.issn.1008-794X.2025.04.003]
　DING Yun,LI Peicheng,CHEN Long,et al.The factors influencing the occurrence of coma caused by acute basilar artery occlusion and the favorable prognosis of mechanical thrombectomy[J].J Intervent Med,2025,34(04):355-361.[doi:10.3969/j.issn.1008-794X.2025.04.003]
点击复制

急性基底动脉闭塞致昏迷及机械清除血栓良好预后的影响因素()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
34
期数:
2025年04
页码:
355-361
栏目:
神经介入
出版日期:
2025-04-23

文章信息/Info

Title:
The factors influencing the occurrence of coma caused by acute basilar artery occlusion and the favorable prognosis of mechanical thrombectomy
文章编号:
1008-794X(2025)-004-0355-07
作者:
丁 运;  李沛城;  陈 珑;  李 波;  袁 晨;  李婉慈;  杨绪森;  顾典一
215006 江苏苏州 苏州大学附属第一医院介入科
Author(s):
DING Yun; LI Peicheng; CHEN Long; LI Bo; YUAN Chen; LI Wanci; YANG Xusen; GU Dianyi.
Department of Interventional Radiology,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215006,China
关键词:
急性基底动脉闭塞;  昏迷;  机械清除血栓;  BATMAN评分;  心血管疾病
分类号:
R654
DOI:
10.3969/j.issn.1008-794X.2025.04.003
文献标志码:
A
摘要:
目的 探讨急性基底动脉闭塞(BAO)患者发生昏迷及机械清除血栓(MT)良好预后的影响因素。方法 回顾性分析2016年1月至2024年4月苏州大学附属第一医院采用MT治疗的102例急性BAO患者临床和影像学资料。根据入院时是否昏迷将患者分为非昏迷组和昏迷组。比较两组间临床及影像资料并进行多因素logistic回归分析确定影响昏迷发生的因素。采用改良Rankin量表(mRS)评分评估患者90 d临床预后。将昏迷组患者进一步分为预后良好组(mRS评分0～3分)和预后不良组(mRS评分4～6分),比较两组患者基线资料及手术资料,并进行多因素logistic回归分析确定影响急性BAO伴昏迷患者MT治疗后良好预后的因素。结果 102例急性BAO患者中入院昏迷54例,非昏迷48例。多因素logistic回归分析结果显示,伴有严重心功能不全或中重度冠状动脉狭窄心血管病(P=0.009)、低BATMAN评分(P<0.001)是急性BAO患者发生昏迷的独立影响因素。接受MT治疗的54例昏迷患者中13例预后良好,41例预后不良。多因素logistic回归分析结果显示,高BATMAN评分(P=0.017)是急性BAO伴昏迷患者MT治疗预后良好的独立影响因素。结论 伴有严重心功能不全或中重度冠状动脉狭窄心血管病、低BATMAN评分的急性BAO患者更易发生昏迷。高BATMAN评分的急性BAO伴昏迷患者MT治疗后预后良好。

参考文献/References:

[1] Lindsberg PJ,Sairanen T,Strbian D,et al.Current treatment of basilar artery occlusion[J].Ann N Y Acad Sci,2012,1268:35-44.
[2]Nguyen TN,Fisher M,Schonewille WJ.Evolution of endovascular therapy trials for basilar artery occlusion[J].J Cereb Blood Flow Metab,2023,43:2005-2007.
[3]Tao C,Nogueira RG,Zhu Y,et al.Trial of endovascular treatment of acute basilar-artery occlusion[J].N Engl J Med,2022,387:1361-1372.
[4]Jovin TG,Li C,Wu L,et al.Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion[J].N Engl J Med,2022,387:1373-1384.
[5]Liu X,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,2020,19:115-122.
[6]Schonewille WJ,Wijman CA,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,2009,8:724-730.
[7]Lenka A,Jankovic J.Tremor syndromes:an updated review[J].Front Neurol,2021,12:684835.
[8]Doria HM,Videira G,Ferreira D,et al.Posterior circulation stroke:coma(more than time)is brain[J].J Stroke Cerebrovasc Dis,2022,31:106313.
[9]中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2023[J].中国卒中杂志,2023,18:684-711.
[10]Yue C,Deng W,Liu J,et al.Endovascular treatment in patients with coma that developed secondary to acute basilar artery occlusion[J].J Neurosurg,2022,137:1491-1500.
[11]Li Y,Fitzgibbons TP,McManus DD,et al.Left ventricular ejection fraction and clinically defined heart failure to predict 90-day functional outcome after ischemic stroke[J].J Stroke Cerebrovasc Dis,2019,28:371-380.
[12]Wang C,Zheng C,Bao J,et al.Predicting asymptomatic coronary artery disease in first-ever acute ischemic stroke patients:a cross-sectional study[J].Quant Imaging Med Surg,2024,14:2441-2454.
[13]Puetz V,Khomenko A,Hill MD,et al.Extent of hypoattenuation on CT angiography source images in basilar artery occlusion:prognostic value in the basilar artery international cooperation study[J].Stroke,2011,42:3454-3459.
[14]Alemseged F,Shah DG,Diomedi M,et al.The basilar artery on computed tomography angiography prognostic score for basilar artery occlusion[J].Stroke,2017,48:631-637.
[15]Jiang L,Yang JH,Ruan J,et al.A single-center experience of endovascular treatment in subtypes of basilar artery occlusion:embolization caused by tandem vertebral artery stenosis may be associated with better outcomes[J].World Neurosurg,2021,151:e918-e926.
[16]Baik SH,Park HJ,Kim JH,et al.Mechanical thrombectomy in subtypes of basilar artery occlusion:Relationship to recanalization rate and clinical outcome[J].Radiology,2019,291:730-737.
[17]Huo X,Sun D,Nguyen TN,et al.First-pass effect of mechanical thrombectomy for anterior circulation large vessel occlusion:incidence,predictors,and clinical impact.Insight from the ANGEL-ACT registry[J].J Neurosurg,2023,139:670-677.
[18]Sun D,Huo X,Raynald,et al.First pass effect of mechanical thrombectomy for acute vertebrobasilar artery occlusion:data from the ANGEL-ACT registry[J].J Neurointerv Surg,2023,15:1201-1206.
[19]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,1998,352:1245-1251.
[20]Ottomeyer C,Zeller J,Fesl G,et al.Multimodal recanalization therapy in acute basilar artery occlusion:long-term functional outcome and quality of life[J].Stroke,2012,43:2130-2135.
[21]倪贵华,梁 晨,赵卫东,等.Solitaire支架血管内治疗急性椎基底动脉闭塞性卒中[J].中华神经医学杂志,2017,16:17-21.
[22]侯贝贝,查明明,朱玉娟,等.急性基底动脉闭塞性脑卒中早期血管内治疗预后的影响因素分析[J].介入放射学杂志,2023,32:899-904.
[23]孟媛媛,钟孟飞,陈晓辉,等.CTA评分对发病6～24 h急性基底动脉闭塞血管内治疗临床结局的预测价值[J].介入放射学杂志,2021,30:1100-1104.
[24]Song K,Li F,Shi M,et al.Basilar artery on computed tomography angiography score and clinical outcomes in acute basilar artery occlusion[J].J Neurol,2022,269:3810-3820.
[25]Alemseged F,Van der Hoeven E,Di Giuliano F,et al.Response to late-window endovascular revascularization is associated with collateral status in basilar artery occlusion[J].Stroke,2019,50:1415-1422.
(收稿日期:2024-09-29)
(本文编辑:谷 珂)

备注/Memo

备注/Memo:
基金项目: 江苏省医学会介入医学专项基金[SYH-3201140-0087(2023034)],苏州大学附属第一医院临床诊疗技术创新项目(2100201)
通信作者: 陈 珑 E-mail:lchen76@163.com
更新日期/Last Update: 2025-04-25