Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke

被引:126
作者
Bouslama, Mehdi [1 ,2 ]
Haussen, Diogo C. [1 ,2 ]
Aghaebrahim, Amin [4 ]
Grossberg, Jonathan A. [1 ,2 ]
Walker, Gregory [3 ]
Rangaraju, Srikant [1 ,2 ]
Horev, Anat [3 ]
Frankel, Michael R. [1 ,2 ]
Nogueira, Raul G. [1 ,2 ]
Jovin, Tudor G. [3 ]
Jadhav, Ashutosh P. [3 ]
机构
[1] Grady Mem Hosp, Dept Neurol, Atlanta, GA USA
[2] Emory Univ, Sch Med, Atlanta, GA USA
[3] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA 15260 USA
[4] Baptist Neurol Inst, Jacksonville, FL USA
关键词
anesthesia; general; reperfusion; stroke; tertiary healthcare; thrombectomy; BASILAR ARTERY-OCCLUSION; SMOKING-THROMBOLYSIS PARADOX; TISSUE-PLASMINOGEN ACTIVATOR; ACUTE ISCHEMIC-STROKE; RECANALIZATION; REVASCULARIZATION; CARE;
D O I
10.1161/STROKEAHA.117.018270
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-Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. Methods-We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. Results-A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P=0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P<0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36-85.96; P=0.025) were associated with good outcome. Conclusions-In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.
引用
收藏
页码:3252 / 3257
页数:6
相关论文
共 25 条
[1]  
Black-Schaffer Randie M, 2004, Top Stroke Rehabil, V11, P23
[2]  
Bouslama M, 2017, STROKE, V48
[3]   Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review [J].
Gory, Benjamin ;
Eldesouky, Islam ;
Sivan-Hoffmann, Rotem ;
Rabilloud, Murielle ;
Ong, Elodie ;
Riva, Roberto ;
Gherasim, Dorin Nicolae ;
Turjman, Alexis ;
Nighoghossian, Norbert ;
Turjman, Francis .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2016, 87 (05) :520-525
[4]   Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].
Goyal, Mayank ;
Menon, Bijoy K. ;
van Zwam, Wim H. ;
Dippel, Diederik W. J. ;
Mitchell, Peter J. ;
Demchuk, Andrew M. ;
Davalos, Antoni ;
Majoie, Charles B. L. M. ;
van der Lugt, Aad ;
de Miquel, Maria A. ;
Donnan, Geoff Rey A. ;
Roos, Yvo B. W. E. M. ;
Bonafe, Alain ;
Jahan, Reza ;
Diener, Hans-Christoph ;
van den Berg, Lucie A. ;
Levy, Elad I. ;
Berkhemer, Olvert A. ;
Pereira, Vitor M. ;
Rempel, Jeremy ;
Millan, Monica ;
Davis, Stephen M. ;
Roy, Daniel ;
Thornton, John ;
San Roman, Luis ;
Ribo, Marc ;
Beumer, Debbie ;
Stouch, Bruce ;
Brown, Scott ;
Campbell, Bruce C. V. ;
van Oostenbrugge, Robert J. ;
Saver, Jeff Rey L. ;
Hill, Michael D. ;
Jovin, Tudor G. .
LANCET, 2016, 387 (10029) :1723-1731
[5]   Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion [J].
Goyal, Nitin ;
Tsivgoulis, Georgios ;
Nickele, Chris ;
Doss, Vinodh T. ;
Hoit, Dan ;
Alexandrov, Andrei V. ;
Arthur, Adam ;
Elijovich, Lucas .
JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2016, 8 (08) :783-786
[6]   Predicting outcome after acute basilar artery occlusion based on admission characteristics [J].
Greving, J. P. ;
Schonewille, W. J. ;
Wijman, C. A. C. ;
Michel, P. ;
Kappelle, L. J. ;
Algra, A. .
NEUROLOGY, 2012, 78 (14) :1058-1063
[7]  
HACKE W, 1995, JAMA-J AM MED ASSOC, V274, P1017, DOI 10.1001/jama.274.13.1017
[8]   Monitored Anesthesia Care vs Intubation for Vertebrobasilar Stroke Endovascular Therapy [J].
Jadhav, Ashutosh P. ;
Bouslama, Mehdi ;
Aghaebrahim, Amin ;
Rebello, Leticia C. ;
Starr, Matthew T. ;
Haussen, Diogo C. ;
Ranginani, Manasa ;
Whalin, Matthew K. ;
Jovin, Tudor G. ;
Nogueira, Raul G. .
JAMA NEUROLOGY, 2017, 74 (06) :704-709
[9]   Smoking-Thrombolysis Paradox Recanalization and Reperfusion Rates After Intravenous Tissue Plasminogen Activator in Smokers With Ischemic Stroke [J].
Kufner, Anna ;
Nolte, Christian H. ;
Galinovic, Ivana ;
Brunecker, Peter ;
Kufner, Gerald M. ;
Endres, Matthias ;
Fiebach, Jochen B. ;
Ebinger, Martin .
STROKE, 2013, 44 (02) :407-413
[10]   Time window for recanalization in basilar artery occlusion Speculative synthesis [J].
Lindsberg, Perttu J. ;
Pekkola, Johanna ;
Strbian, Daniel ;
Sairanen, Tiina ;
Mattle, Heinrich P. ;
Schroth, Gerhard .
NEUROLOGY, 2015, 85 (20) :1806-1815