Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-02-25 DOI:10.1177/23969873241234713
Adam T Mierzwa, Ashley Nelson, Sami Al Kasab, Santiago Ortega Gutierrez, Juan Vivanco-Suarez, Mudassir Farooqui, Ashutosh P Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh N Nguyen, Piers Klein, Mohamad Abdalkader, Hisham Salahuddin, Aditya Pandey, Zachary Wilseck, Sravanthi Koduri, Niraj Vora, Nameer Aladamat, Khaled Gharaibeh, Ehad Afreen, Hisham Al-Hajala, Julie Shawver, Syed Zaidi, Mouhammad Jumaa
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Abstract

Introduction: Recent randomized controlled trials demonstrated superiority of mechanical thrombectomy compared to medical therapy in acute basilar artery occlusions, however, little data is available to guide clinicians in functional prognosis and risk stratification.

Patients and methods: Data from the retrospectively established PC-SEARCH Thrombectomy registry, which included patients with basilar artery occlusion from eight sites from January 2015 to December 2021, was interrogated. Outcomes were dichotomized into 90-day favorable (mRS ⩽ 3) and unfavorable (mRS > 3). Multivariate logistic regression analysis was performed with respect to the outcome groups and were adjusted for potential confounding baseline characteristics.

Results: Four-hundred-forty-four patients were included in this analysis. Mean age was 66 [SD 15], with 56% male, and comprised of 76% Caucasian. Patients presented with an initial median NIHSS of 18 and 199 patients (44.8%) achieved favorable 90-day functional outcomes. Independent predictors of favorable outcomes included younger age, pc-ASPECTS > 8 (OR 2.30 p < 0.001), and TICI ⩾ 2b (OR 7.56 p < 0.001). Unfavorable outcomes were associated with increasing number of passes (OR 1.29 p = 0.004) and sICH (OR 4.19 p = 0.015). IA-tPA was an independent risk factor for sICH (OR 7.15 p = 0.002) without improving favorable functional outcomes.

Conclusion and discussion: PC-ASPECTS > 8, successful recanalization (TICI ⩾ 2b), first-pass recanalization, and younger age are independent predictors of favorable 90-day functional outcome in thrombectomy treated patients with acute basilar artery occlusion. Conversely, sICH were independent predictors of unfavorable outcomes. IA-tPA and unsuccessful recanalization are independently associated with sICH.

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急性基底动脉闭塞症的预后和无症状颅内出血:PC-SEARCH血栓切除登记分析。
简介:最近的随机对照试验表明,在急性基底动脉闭塞症中,机械性血栓切除术优于药物治疗,然而,几乎没有数据可用于指导临床医生进行功能性预后和风险分层:研究人员查询了回顾性建立的 PC-SEARCH 血栓切除术登记处的数据,该登记处纳入了 2015 年 1 月至 2021 年 12 月期间来自 8 个地点的基底动脉闭塞患者。结果分为90天良好(mRS ⩽3)和不良(mRS > 3)。对结果分组进行了多变量逻辑回归分析,并对潜在的混杂基线特征进行了调整:本次分析共纳入了 44 名患者。平均年龄为 66 岁 [SD 15],男性占 56%,白种人占 76%。患者最初的 NIHSS 中位数为 18,199 名患者(44.8%)获得了良好的 90 天功能预后。良好预后的独立预测因素包括年龄较小、pc-ASPECTS > 8(OR 2.30 p p = 0.004)和sICH(OR 4.19 p = 0.015)。IA-tPA是导致sICH的独立危险因素(OR 7.15 p = 0.002),但不会改善良好的功能预后:结论:PC-ASPECTS > 8、成功再通畅(TICI ⩾2b)、首次再通畅和年龄较小是血栓切除术治疗急性基底动脉闭塞患者 90 天功能预后良好的独立预测因素。相反,sICH 则是不良预后的独立预测因素。IA-tPA和不成功的再通与sICH独立相关。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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