Recanalization is more important than procedure time on outcome of thrombectomy in acute vertebrobasilar artery occlusion.

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thrombosis and Thrombolysis Pub Date : 2025-03-13 DOI:10.1007/s11239-025-03082-6
Wenya Lan, Danyu Feng, Kefan Qiu, Mingyang Du, Feng Qiu, Lulu Xiao, Wen Sun, Zhongming Qiu, Hongfei Sang, Lingfei Li, Kefeng Luan, Xinfeng Liu, Hui Cao
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Abstract

Longer procedure time (PT) predicts worse prognosis after endovascular treatment (EVT) in acute vertebrobasilar artery occlusion (VBAO), but it remains unknown whether it is worth pursuing recanalization when the PT is obviously extended. Patients with acute VBAO who received EVT were retrospectively enrolled from 21 stroke centers in China from December 2015 to December 2018. Multivariable logistic analysis was performed to analyze the associations of PT with favorable outcome (defined as modified Rankin Scale score of 0 to 3) and mortality at 90 days. A total of 541 patients with median age of 64 years (IQR, 55-73) were included. The median baseline National institutes of Health stroke scale score was 23 (IQR, 14-28) and PT was 110 min (IQR, 74-156). The rate of favorable outcome was 36.5% in patients with PT 111-155 min (adjusted OR 0.51 [95% CI 0.28-0.92]) and 33.3% in patients with PT > 155 min (adjusted OR 0.52 [95% CI 0.29-0.93]) compared with 42.9% in patients with PT ≤ 75 min. Compared with the PT ≤ 75 min, PT of 111-155 min (adjusted OR 1.96 [95% CI 1.11-3.46]) and PT > 155 min (adjusted OR 2.10 [95% CI 1.21-3.66]) were associated with increased risks of mortality. Recanalization within four PT intervals were consistently associated with better outcomes compared with failure of recanalization (all P < 0.05). For acute VBAO patients treated with EVT, recanalization regardless of PT was associated with improved prognosis than failure of recanalization, supporting the continued pursuit of recanalization despite the PT being obviously extended. The findings need validation in randomized controlled trials.

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较长的手术时间(PT)可预测急性椎基底动脉闭塞(VBAO)血管内治疗(EVT)后较差的预后,但当PT明显延长时是否值得继续再通畅仍是未知数。2015年12月至2018年12月,中国21个卒中中心回顾性纳入了接受EVT治疗的急性VBAO患者。研究人员进行了多变量逻辑分析,以分析PT与良好预后(定义为改良Rankin量表评分0至3分)和90天死亡率的关系。共纳入541名患者,中位年龄为64岁(IQR,55-73)。美国国立卫生研究院卒中量表基线评分中位数为 23 分(IQR,14-28),PT 为 110 分钟(IQR,74-156)。PT 111-155 分钟患者的良好预后率为 36.5%(调整后 OR 0.51 [95% CI 0.28-0.92]),PT >155 分钟患者的良好预后率为 33.3%(调整后 OR 0.52 [95% CI 0.29-0.93]),而 PT ≤75 分钟患者的良好预后率为 42.9%。与 PT ≤ 75 分钟相比,PT 111-155 分钟(调整 OR 1.96 [95% CI 1.11-3.46])和 PT > 155 分钟(调整 OR 2.10 [95% CI 1.21-3.66])与死亡风险增加相关。与未能再通畅相比,在四个 PT 间隔内再通畅与更好的预后一直相关(所有 P
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来源期刊
CiteScore
9.20
自引率
0.00%
发文量
112
审稿时长
4-8 weeks
期刊介绍: The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists, hematologists, vascular medicine specialists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. The principal focus of the Journal centers on the pathobiology of thrombosis and vascular disorders and the use of anticoagulants, platelet antagonists, cell-based therapies and interventions in scientific investigation, clinical-translational research and patient care. The Journal will publish original work which emphasizes the interface between fundamental scientific principles and clinical investigation, stimulating an interdisciplinary and scholarly dialogue in thrombosis and vascular science. Published works will also define platforms for translational research, drug development, clinical trials and patient-directed applications. The Journal of Thrombosis and Thrombolysis'' integrated format will expand the reader''s knowledge base and provide important insights for both the investigation and direct clinical application of the most rapidly growing fields in medicine-thrombosis and vascular science.
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