Vertebrobasilar Artery Occlusion Treatment Outcomes Within 24 hours of Estimated Occlusion Time.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2024-09-09 DOI:10.1227/neu.0000000000003160

Yingjie Xu, Pan Zhang, Miaomiao Hu, Wen Sun, Guoqiang Xu, Chunyan Dai

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Abstract

Background and objectives: The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO) within 24 hours of estimated occlusion time (EOT) and to evaluate the effect of early and late time window in a cohort of patients with VBAO treated with EVT.

Methods: Retrospective analysis was conducted on patients within 24 hours of the EOT in 65 stroke centers in China. Favorable outcome was defined as modified Rankin Scale ≤3 at 90 days. Patients were divided into the medical management (MM) group and the EVT group. Times were dichotomized into early (EOT ≤6 hours) and late (>6 hours) time windows. Multivariate logical regression models were used to evaluate the efficacy and safety of EVT and the effect of time windows on outcomes in EVT patients.

Results: Among 4124 patients, 2473 and 1651 patients were included in the early and late windows, respectively. 1702 patients received MM and 2422 were treated with EVT. EVT was associated with a higher rate of a favorable outcome at 90 days both in early (odds ratio [OR] 2.16, 95% CI 1.94-2.41) and late (OR 1.89, 95% CI 1.65-2.17) time windows. No differences were found regarding favorable outcome (OR 0.95, 95% CI 0.87-1.03) between VBAO patients treated with EVT within and beyond 6 hours.

Conclusion: Patients with acute VBAO who received EVT within 24 hours were associated with improved favorable outcome compared with patients who received MM. EVT beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.

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估计闭塞时间 24 小时内的椎基底动脉闭塞治疗结果。

背景和目的：本研究旨在探讨在估计闭塞时间（EOT）24小时内对急性椎基底动脉闭塞（VBAO）患者进行血管内治疗（EVT）的疗效和安全性，并评估EVT治疗VBAO患者队列中早期和晚期时间窗的影响：方法：对中国 65 个卒中中心的 EOT 24 小时内患者进行回顾性分析。90天后改良Rankin量表≤3为良好预后。患者被分为医疗管理（MM）组和EVT组。时间分为早期（EOT ≤6小时）和晚期（>6小时）时间窗。采用多变量逻辑回归模型评估EVT的疗效和安全性，以及时间窗对EVT患者预后的影响：在4124名患者中，分别有2473名和1651名患者被纳入早期和晚期时间窗。1702名患者接受了MM治疗，2422名患者接受了EVT治疗。在早期（几率比[OR] 2.16，95% CI 1.94-2.41）和晚期（OR 1.89，95% CI 1.65-2.17）时间窗，EVT 与 90 天的良好预后率较高相关。在6小时内和6小时后接受EVT治疗的VBAO患者在良好预后方面（OR 0.95，95% CI 0.87-1.03）没有发现差异：结论：与接受MM治疗的患者相比，在24小时内接受EVT治疗的急性VBAO患者的预后更好。超过6小时的EVT是可行且安全的，不会增加无症状性颅内出血。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.