Response to Late-Window Endovascular Revascularization Is Associated With Collateral Status in Basilar Artery Occlusion

被引：58

作者：

Alemseged, Fana ^{[1
,4
]}

Van der Hoeven, Erik ^{[7
]}

Di Giuliano, Francesca ^{[5
,6
]}

Shah, Darshan ^{[1
]}

Sallustio, Fabrizio ^{[4
]}

Arba, Francesco ^{[9
]}

Kleinig, Timothy J. ^{[11
]}

Bush, Steven ^{[2
]}

Dowling, Richard J. ^{[2
]}

Yan, Bernard ^{[1
]}

Sharma, Gagan ^{[1
]}

Limbucci, Nicola ^{[10
]}

Floris, Roberto ^{[5
]}

Donnan, Geoffrey A. ^{[3
]}

Puetz, Volker ^{[12
,13
]}

Diomedi, Marina ^{[4
]}

Parsons, Mark W. ^{[1
]}

Mitchell, Peter J. ^{[2
]}

Davis, Stephen M. ^{[1
]}

Yassi, Nawaf ^{[1
,3
]}

Schonewille, Wouter J. ^{[8
]}

Campbell, Bruce C. V. ^{[1
]}

Ng, J. L. ^{[14
]}

Williams, C. ^{[14
]}

Zhao, H. ^{[14
]}

McDonald, A. ^{[14
]}

Pesavento, L. ^{[14
]}

Coote, S. ^{[14
]}

Ng, F. C. ^{[15
]}

Thijs, V. ^{[15
]}

Drew, R. ^{[16
]}

Esperon, C. Garcia ^{[17
]}

Spratt, N. ^{[17
]}

Wu, T. ^{[18
]}

Fink, J. ^{[18
]}

Rocco, A. ^{[19
]}

Nappini, S. ^{[20
]}

Morotti, A. ^{[21
]}

Cavallini, A. ^{[21
]}

Kaiser, D. ^{[22
]}

Geber, J. ^{[22
]}

Schwabova, J. P. ^{[23
]}

Tomek, A. ^{[23
]}

Boulouis, G. ^{[24
]}

Benhassen, W. ^{[24
]}

Oxley, T. J. ^{[25
]}

Fifi, J. T. ^{[25
]}

机构：

[1] Univ Melbourne, Dept Med & Neurol, Parkville, Vic, Australia

[2] Univ Melbourne, Dept Radiol, Parkville, Vic, Australia

[3] Univ Melbourne, Royal Melbourne Hosp, Florey Inst Neurosci & Mental Hlth, Parkville, Vic, Australia

[4] Univ Hosp Tor Vergata, Stroke Unit, Dept Neurosci, Rome, Italy

[5] Univ Hosp Tor Vergata, Dept Biomed & Prevent, Rome, Italy

[6] Univ Hosp Tor Vergata, Dept Diagnost & Mol Imaging Intervent Radiol & Ra, Rome, Italy

[7] St Antonius Hosp, Dept Radiol, Nieuwegein, Netherlands

[8] St Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

[9] Univ Florence, NEUROFARBA Dept, Florence, Italy

[10] Careggi Univ Hosp, Neurovasc Intervent Unit, Florence, Italy

[11] Royal Adelaide Hosp, Dept Neurol, Adelaide, SA, Australia

[12] Univ Technol Dresden, Dept Neurol, Dresden, Germany

[13] Univ Technol Dresden, Dresden Neurovasc Ctr, Dresden, Germany

[14] Royal Melbourne Hosp, Parkville, Vic, Australia

[15] Austin Hosp, Melbourne, Vic, Australia

[16] Royal Adelaide Hosp, Adelaide, SA, Australia

[17] John Hunter Hosp, New Lambton Hts, NSW, Australia

[18] Christchurch Hosp, Christchurch, New Zealand

[19] Univ Hosp Tor Vergata, Rome, Italy

[20] Careggi Univ Hosp, Florence, Italy

[21] IRCCS Neurol Inst C Mondino & Policlin S Matteo, Pavia, Italy

[22] Univ Technol Dresden, Dresden, Germany

[23] Univ Hosp Motol, Prague, Czech Republic

[24] Sainte Anne Hosp, Paris, France

[25] Mt Sinai Hosp, New York, NY 10029 USA

来源：

STROKE | 2019年 / 50卷 / 06期

基金：

英国医学研究理事会;

关键词：

basilar artery; computed tomography angiography; reperfusion; stroke; thrombectomy; time-to-treatment; ISCHEMIC-STROKE; OUTCOMES; RECANALIZATION; THROMBECTOMY; PREDICTORS; TIME; SCORE; THROMBOLYSIS; IMPACT;

D O I：

10.1161/STROKEAHA.118.023361

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose The benefit of endovascular therapy in extended time windows has been demonstrated in patients with anterior circulation large vessel occlusion ischemic stroke and favorable imaging profile. We evaluated whether collaterals and thrombus burden influence the associations between revascularization, time-to-treatment, and outcome in endovascular therapy-treated patients with basilar artery occlusion. Methods We retrospectively analyzed clinical and imaging data of consecutive endovascular therapy-treated patients with basilar artery occlusion included in the multicenter Basilar Artery Treatment and Management Collaboration. The BATMAN (Basilar Artery on Computed Tomography Angiography score, which evaluates thrombus burden and collaterals) and the PC-CS (Posterior Circulation Collateral score, which evaluates collaterals) were assessed on computed tomography angiography, blinded to clinical outcome. Good outcome was defined as modified Rankin Scale score of 3 within 3 months; revascularization (successful reperfusion) as modified Thrombolysis in Cerebral Infarction 2b-3 (or TIMI [Thrombolysis in Myocardial Infarction] 2-3 in the BASICS [Basilar Artery International Cooperation Study] registry). Results We included 172 patients with basilar artery occlusion treated with endovascular therapy (124 with mechanical thrombectomy): mean (SD) age 65 (13) years, median National Institutes of Health Stroke Scale 22 (interquartile range 12-30), 64 (37%) treated >6 hours. Revascularization (achieved in 79% of patients) was associated with good outcome (P=0.003). The use of new generation thrombectomy devices was associated with good outcome (P=0.03). In patients who achieved revascularization, 29/46 (63%) of patients with a favorable BATMAN score and 26/51 (51%) with favorable PC-CS had good outcomes. In logistic regression analysis (adjusted for age, National Institutes of Health Stroke Scale, and time-to-treatment 6/>6 hours), revascularization was associated with good outcome in patients with favorable BATMAN score (odds ratio, 15.8; 95% CI, 1.4-175; P=0.02) or PC-CS (odds ratio, 9.4; 95% CI, 1.4-64; P=0.02). In patients who achieved revascularization, early (time-to-treatment 6 hours) but not late treatment was associated with improved outcome in patients with unfavorable BATMAN score (18/52 [35%]; odds ratio, 15; 95% CI, 1.9-124; P=0.01) or PC-CS (16/44 [36%]; odds ratio, 5.5; 95% CI, 1.4-21; P=0.01). Conclusions Revascularization is associated with good outcome in patients with basilar artery occlusion with good collaterals and less extensive occlusion, even >6 hours after onset.

引用

页码：1415 / 1422

页数：8

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