新型DSA侧支量表用于预测急性基底动脉闭塞血管内治疗后无效再通的单中心研究  

A novel DSA-based collateral scale for prediction of futile recanalization in acute basilar artery occlusion: a single-center observational study

作　　者：佟旭[1] 孙瑄[1] 王伊龙[2] 王文志[3] 缪中荣[1] 高峰[1] Tong Xu;Sun Xuan;Wang Yilong;Wang Wenzhi;Miao Zhongrong;Gao Feng(Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经介入中心,100070 [2]首都医科大学附属北京天坛医院神经病学中心,100070 [3]北京市神经外科研究所,100070

出　　处：《中华放射学杂志》2021年第2期173-179,共7页Chinese Journal of Radiology

基　　金：北京市科委“首都临床特色应用研究”专项课题(Z18110000171837);中国博士后科学基金面上资助项目(2019M650773);科技部“十三五”国家重点研发计划(2016YFC1301500);河北省卫计委医学科学研究重点科技研究计划(20181258)。

摘　　要：目的:探讨新型DSA侧支量表用于预测急性基底动脉闭塞(BAO)血管内治疗(EVT)术后无效再通风险的价值。方法:前瞻性连续收集首都医科大学附属北京天坛医院2012年1月至2018年7月接受EVT的148例急性BAO患者。新型DSA侧支量表基于术前DSA图像评价基底动脉的侧支循环,分为4级,1~2级为侧支代偿差、3级为侧支代偿可、4级为侧支代偿好。无效再通定义为EVT术后BAO成功再通[改良脑梗死溶栓(mTICI)分级≥2b级],但术后90 d预后不良(改良Rankin量表>3分)。采用加权Kappa系数评价新型DSA侧支量表的观察者间一致性;采用多因素logistic回归模型用于验证该侧支量表与无效再通的独立相关性;按照年龄、发病到穿刺时间、卒中严重程度和病因分型进行分层,观察不同亚组之间该侧支量表对无效再通的预测作用是否相同。结果:本研究共纳入148例BAO患者,其中69例(46.6%)发生了无效再通。新型DSA侧支量表分级1~4级患者分别为3、25、78、42例,无效再通发生率依次为100%(3/3)、72.0%(18/25)、47.4%(37/78)和26.2%(11/42),呈逐渐下降趋势。新型DSA侧支量表的两名观察者间一致性非常高(加权Kappa=0.95,95%CI 0.91~0.99)。多因素logistic分析显示新型DSA侧支量表与无效再通呈独立负相关(校正OR值0.47,95%CI 0.23~0.98)。亚组分析显示在预测无效再通时,该侧支量表与年龄、发病到穿刺时间、卒中严重程度和病因分型均不存在交互作用(交互P值>0.10)。结论:新型DSA侧支量表可作为预测急性BAO患者EVT术后发生无效再通的有效可靠指标。Objective To develop a novel collateral scale based on DSA for predicting futile recanalization of acute basilar artery occlusion(BAO)after endovascular therapy(EVT).Methods A prospectively registered consecutive cohort of 148 BAO patients treated with EVT from January 2012 to July 2018 in Beijing Tiantan Hospital Capital Medical University was reviewed.The novel DSA-based collateral scale had 4 grades for poor(Grade 1-2),intermediate(Grade 3)and good(Grade 4)collateral status.Futile recanalization was defined as the occurrence of poor outcome(modified Rankin scale>3)at 90 d despite successful recanalization(modified thrombolysis in cerebral infarction≥2b)after EVT.Interobserver agreement for the proposed collateral scale was assessed by Kappa coefficient.The independent association of the collateral scale with futile recanalization was evaluated by multivariable logistic regression,and the effects of the collateral scale on futile recanalization in different subgroups stratified by age,time window,severity and etiology of stroke were also explored.Results Of 148 patients in this study,69(46.6%)suffered from futile recanalization.There were 3,25,78 and 42 patients with grade 1 to 4 of the novel DSA-based collateral scale,and the incidence of futile recanalization was 100%(3/3),72.0%(18/25),44.4%(37/78)and 26.2%(11/42),respectively,showing a downward trend.Interobserver agreement of the proposed collateral scale was excellent(weighted Kappa=0.95,95%CI 0.91-0.99).A multivariable logistic analysis showed that the collateral scale was significantly associated with futile recanalization(adjusted OR=0.47,95%CI 0.23-0.98).And the effects of the collateral scale on futile recanalization were consistent across all subgroups(P>0.1 for all interactions).Conclusion The novel DSA-based collateral scale may be a valid and reliable predictor of futile recanalization in BAO patients treated with EVT.

关 键 词：基底动脉 动脉闭塞性疾病 侧支循环 血管造影术 数字减影 无效再通 

分 类 号：R743.3[医药卫生—神经病学与精神病学]