后循环CTA评分对急性基底动脉闭塞机械取栓临床结局的预测作用研究

doi:10.3969/j.issn.1673-5765.2018.12.003

摘要/Abstract

摘要：

目的通过脑血管造影来评估及验证后循环计算机断层扫描血管成像（p o ste ri or c i rcu l ati o n computed tomography angiography，pc-CTA）评分在急性基底动脉闭塞患者使用支架取栓装置机械取栓后对临床结局的预测作用。

方法回顾性分析86例连续入组的急性基底动脉闭塞患者的临床特征及脑血管造影数据。血管成功开通定义为脑梗死溶栓（thrombolysis in cerebral infarction，TICI）分级2b/3级，临床良好预后定义为 3个月时改良Rankin量表（modified Rankin scale，mRS）评分0～2分。对pc-CTA评分进行受试者工作特征（receiver operating characteristic，ROC）曲线分析来测定曲线下面积及最佳界点值。多因素回归分析明确3个月时临床结局的独立预测因素。

结果本研究共纳入86例急性基底动脉闭塞进行机械取栓的患者，78例（90.7%）血管成功再通（TICI 2b/3级），30例（34.9%）临床预后良好。单因素分析中预后良好及预后不良组pc-CTA评分比较，差异有统计学意义（P =0.005）。对pc-CTA评分进行ROC分析，结果提示曲线下面积是0.681[95%可信区间（confidence interval，CI）0.572～0.778]，最佳界点值是2分（敏感度=53.33%，特异度=80.36%）。进行多因素Logistic回归分析提示，pc-CTA评分≤2分为急性基底动脉闭塞机械取栓后3个月时良好结局的独立预测因素[比值比3.831，95%CI 1.302～11.273，P =0.015]。

结论 pc-CTA评分可独立预测急性基底动脉闭塞患者机械取栓的短期临床预后。

文章导读： 单因素和多因素分析结果表明基于CT血管造影的pc-CTA评分可以独立预测急性基底动脉闭塞患者机械取栓后的3个月临床结局。

关键词: 基底动脉闭塞; 机械取栓; 后循环计算机断层扫描血管成像评分; 临床结局

Abstract:

Objective To assess and validate the value of posterior circulation computed tomography angiography (pc-CTA) score in predicting the clinical outcome of mechanical thrombectomy in patients with acute basilar artery occlusion (BAO) using cerebral digital subtraction angiography (DSA).

Methods The clinical and angiographic data of 86 consecutive patients with acute BAO were retrospectively analyzed. The pc-CTA score was used to assess thrombus burden. Successful recanalization was defined as thrombolysis in cerebral infarction (TICI) score 2b/3. Favorable outcome was defined as a modified Rankin scale (mRS) score of 0-2 at 3 months. Receiver operating characteristic (ROC) curve was used to determine the area under the curve (AUC) and the optimal cutoff value. Multivariate logistic regression analysis was used to identify the independent predictor of clinical outcome at 3 months.

Results A total of 86 acute BAO patients who had undergone mechanical thrombectomy were identified: 78 (90.7%) achieved successful recanalization (TICI 2b/3) and 30 (34.9%) had a favorable outcome (mRS 0-2). The univariate analysis showed that there was significant difference in the pc-CTA score between favorable outcome and poor outcome groups (P =0.005). ROC analysis indicated that the AUC of the pc-CTA score was 0.681 [95% confidence interval (CI) 0.572-0.778], and the optimal cutoff value was 2 (sensitivity: 53.33%, specificity: 80.36%). The multivariate logistic regression analysis showed that the pc-CTA score ≤2 could independently predict the 3-month favorable outcome in acute BAO patients treated with mechanical thrombectomy (odds ratio 3.831; 95%CI 1.302-11.273, P =0.015).

Conclusions The pc-CTA score may independently predict the short clinical outcome in acute BAO patients treated with thrombectomy.

Key words: Basilar artery occlusion; Mechanical thrombectomy; pc-CTA score; Clinical outcome

杨海华, 马宁, 刘恋, 莫大鹏, 高峰, 缪中荣. 后循环CTA评分对急性基底动脉闭塞机械取栓临床结局的预测作用研究[J]. 中国卒中杂志, 2018, 13(12): 1243-1250.

YANG Hai-Hua, MA Ning, LIU Lian, MO Da-Peng, GAO Feng, MIAO Zhong-Rong. The Predictive Value of Posterior Circulation Computed Tomography Angiography Score in Outcome of Mechanical Thrombectomy for Acute Basilar Artery Occlusion[J]. Chinese Journal of Stroke, 2018, 13(12): 1243-1250.

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