Data_Sheet_1_Effect of vertebrobasilar dolichoectasia on endovascular therapy in acute posterior circulation infarction.PDF

Background and purposeThis study aimed to analyze the feasibility and safety of endovascular therapy (EVT) in patients with acute posterior circulation stroke and vertebrobasilar dolichoectasia (VBD).Materials and methodsBASILAR was a national prospective registry of consecutive patients with symptomatic and imaging-confirmed acute stroke in the posterior circulation within 24 h of symptom onset. We evaluated EVT feasibility and safety in patients with VBD. Primary outcomes included improvement in modified Rankin Scale scores (mRS) at 90 days and mortality within 90 days. The secondary outcome was the rate of favorable functional outcome, defined as mRS ≤ 3 (indicating independent ambulation) at 90 days. Safety outcomes included surgery-related complications and other serious adverse events.ResultsA total of 534 cases were included: 159 with VBD and 375 controls. No significant difference in mRS at 90 days was found between groups, but patients with VBD had a higher baseline National Institutes of Health Stroke Scale (NIHSS) score [30 (19–33) vs. 25 (15–32)] and were older [65 (59–74) vs. 63 (55–72) year]. After propensity score matching, there were no significant differences in baseline NIHSS score between the two groups, and the efficacy and safety of EVT were similar between patients with or without VBD. Furthermore, the prognostic effect of puncture-to-recanalization time on the probability of mortality within 90 days in EVT-treated patients with VBD was significant {adjusted odds ratio, 1.008 [95% confidence interval (1.001–1.015)]}.ConclusionEndovascular therapy is safe and feasible in patients with acute posterior circulation stroke and VBD. The puncture-to-recanalization time is important for predicting the prognosis of EVT-treated patients with VBD.

背景与目的本研究旨在分析对急性后循环卒中合并椎基底动脉扩张症（VBD）患者进行血管内治疗（EVT）的可行性和安全性。研究方法BASILAR是一项针对连续患者的全国性前瞻性登记研究，这些患者在症状出现后24小时内出现症状性且经影像学证实的后循环急性卒中。我们评估了VBD患者在EVT中的可行性和安全性。主要结局指标包括90天时改良Rankin量表（mRS）评分的改善以及90天内的死亡率。次要结局指标为良好的功能结局发生率，定义为90天时mRS ≤ 3（表示独立行走）。安全性结局包括手术相关并发症和其他严重不良事件。结果共纳入534例病例：159例为VBD患者，375例为对照组。在两组之间，90天时的mRS评分没有显著差异，但VBD患者的基线美国国立卫生研究院卒中量表（NIHSS）评分更高[30（19–33）比25（15–32）]，且年龄更大[65（59–74）比63（55–72）岁]。经过倾向评分匹配后，两组之间的基线NIHSS评分没有显著差异，EVT治疗患者的疗效和安全性在有无VBD患者之间相似。此外，对于VBD接受EVT治疗的患者的90天内死亡概率，穿刺至再通时间对预后的预测作用具有统计学意义{调整后的优势比，1.008 [95%置信区间（1.001–1.015）]}。结论对于急性后循环卒中合并VBD的患者，血管内治疗是安全且可行的。穿刺至再通时间是预测VBD接受EVT治疗患者预后的重要因素。