血管内治疗对不同病变性质急性基底动脉闭塞患者预后的影响
陈科春1） 吴秋义1） 周 寅1） 张雯君1） 肖国栋2） 刘慧慧2）
1）苏州大学附属张家港医院，江苏 张家港 215600 2）苏州大学附属第二医院，江苏 苏州 215004
通信作者：陈科春
【摘要】 目的 评估血管内治疗对不同病变性质导致的急性基底动脉闭塞性脑卒中患者预后的影响。方法 连续回顾性分析 2017-11—2021-11 在苏州大学附属张家港医院（31 例）和苏州大学附属第二医院（50 例）行血管内治疗的急性基底动脉闭塞患者 81 例，按照有无基底动脉狭窄（BAS）分 BAS 组和无 BAS 组，比较 2 组患者的临床、影像、手术资料，对比分析 2 组的预后结局。对 BAS 组进一步按血管成形术分亚组，比较预后。结果 共纳入 BAS 组患者 56 例，无 BAS 组患者 25 例，其女性比例更高（48.0% vs 19.6%，P=0.009），BAS 组的高血脂比例（25% vs 0，P=0.004）、吸烟比例（53.6% vs 24.0%，P=0.013）、入院低密度脂蛋白［2.96（2.60~3.59） vs 2.62（1.91~2.75），P=0.006］更高，BAS 组患者 pc-ASPECTS 评分低于无 BAS 组患者［7（6~8） vs 8（7~8），P=0.01］，采用血管内成形术 BAS 组更高（33.9% vs 8.0%，P=0.014）。2 组的成 功再灌注 mTICI 2b~3、病变血管部位、穿刺-复流时间、rt-PA 静脉溶栓率差异均无统计学意义（P>0.05）。经校正性别、年龄、吸烟、pc-ASPECTS、低密度脂蛋白、术后 mTICI 2b~3 比例等因素后，BAS 组相比无 BAS 组，90 d 良好预后 mRS（0~2）更低（OR=0.20，95%CI：0.40~0.96，P=0.044），90 d 有利预后 mRS（0~3）、症状性颅内出血、90 d 内死亡 2 组无统计学差异（P>0.05）。BAS 组内有无血管成形术亚组比较，90 d 良好预后、症状性颅内出血、死亡无统计学差异。结论 急性基底动脉闭塞患者中 BAS 和无 BAS 组的血管内治疗再通率、手术时间无统计学差异，但合并 BAS 患者的 90 d 良好预后低于无 BAS 患者，而症状性颅内出血及死亡两者无显著差异。BAS 患者中是否行血管内成形术对预后无影响。
【关键词】 急性基底动脉闭塞；血管内治疗；基底动脉狭窄；血管成形；预后
【中图分类号】 R743 【文献标识码】 A 【文章编号】 1673-5110（2022）08-0929-06
Effect of intravascular therapy on prognosis of patients with acute basilar artery occlusion
caused by different pathological properties
CHEN Kechun1） ，WU Qiuyi1） ，ZHOU Yin1） ，ZHANG Wenjun1） ，XIAO Guodong2） ，LIU Huihui2）
1）Zhangjiagang Hospital of Soochow University，Zhangjiagang 215600，China；
2）The Second Affiliated Hospital of
Soochow University，Suzhou 215004，China
Corresponding author：CHEN Kechun
【Abstract】 Objective To evaluate the effect of intravascular therapy on the prognosis of patients with acute basilar artery occlusion stroke caused by different pathological properties. Methods Totally 81 patients with acute basilar artery occlusion who underwent endovascular treatment in Zhangjiagang Hospital of Soochow University（31 cases）and the Second Affiliated Hospital of Soochow University（50 cases）from November 2017 to November 2021 were analyzed retrospectively. The patients were divided into BAS group and non BAS group ac⁃ cording to whether there was basilar artery stenosis（BAS）. The clinical，imaging and surgical data of the twogroups were compared，and the prognosis and outcome of the two groups were compared and analyzed. Bas group was further divided into subgroups according to angioplasty，and the prognosis was compared. Results A total of 56 pa⁃ tients with BAS and 25 patients with non BAS were included. The proportion of women in the non BAS group was higher （48.0% vs 19.6%，P=0.009）. The proportion of hyperlipidemia（25% vs 0，P=0.004）and smoking（53.6% vs 24.0%，P=0.013）in BAS group were higher. The admission lowdensity lipoprotein in BAS group was higher than that in non BAS patients［2.96（2.60-3.59）vs 2.62（1.91-2.75），P=0.006］，and the pc-ASPECTS was lower than that in non BAS patients［7（6-8）vs 8（7-8），P=0.01］. Patients with BAS who underwent endovascular angioplasty were higher than those with non BAS（33.9% vs 8.0%，P=0.014）. There was no significant difference in successful reperfusion mTICI 2b-3，lesion vessel location，puncture reflow time and intravenous thrombolysis rate of rt-PA between the two groups （P>0.05）. After adjusting for gender，age，smoking，pc-ASPECTS，low density lipoprotein and postoperative mTICI 2b-3. Compared with non BAS group，the 90 day good prognosis mRS（0-2）in BAS group was lower，OR=0.20，95% CI：0.40-0.96，P=0.044.There was no significant difference in 90 day favorable prognosis mRS（0-3），symptomatic intracranial hemorrhage and death within 90 days between the two groups（P>0.05）. There was no significant difference in 90 day good prognosis，symptomatic intracranial hemorrhage and death between the BAS group with and without angio⁃plasty. Conclusion In patients with acute basilar artery occlusion，there was no significant difference in recanalization rate and operation time between bas and non bas groups. However，the 90 day good prognosis of patients with BAS was lower than that of patients without BAS，and there was no significant difference between symptomatic intracranial hemor⁃ rhage and death. Endovascular angioplasty has no effect on the prognosis of BAS patients。
【Key words】 Acute basilar artery occlusion；Endovascular therapy；Basilar artery stenosis；Angioplasty；Prognosis
