CTA评分对发病6~24 h急性基底动脉闭塞血管内治疗临床结局的预测价值  

The value of computed tomography angiography score in predicting the clinical outcome of patients with acute basilar artery occlusion receiving endovascular recanalization within 6-24 hours after onset

作　　者：孟媛媛[1] 钟孟飞[1] 陈晓辉[1] 张立功[1] 高宗恩[1] MENG Yuanyuan;ZHONG Mengfei;CHEN Xiaohui;ZHANG Ligong;GAO Zongen(Department of Neurology,Shengli Oilfield Central Hospital,Dongying,Shandong Province 257034,China)

机构地区：[1]胜利油田中心医院神经内科,山东东营257034

出　　处：《介入放射学杂志》2021年第11期1100-1104,共5页Journal of Interventional Radiology

摘　　要：目的探讨CTA评分系统对急性基底动脉闭塞(BAO)6~24 h患者血管内治疗后早期临床结局的预测价值。方法回顾性分析2014年1月至2019年12月在胜利油田中心医院接受血管内治疗的53例急性BAO患者临床资料。根据改良Rankin量表(mRS)评分结果,将患者分为预后良好组(n=32)、预后不良组(n=21)。采用后循环侧支循环评分(pc-CS)、后循环(pc)-CTA侧支评分、基底动脉BATMAN评分,对血管内介入术前患者CTA影像进行评估。结果预后良好组、预后不良组患者年龄、取栓前和出院NIHSS评分、pc-CS评分、pc-CTA评分、BATMAN评分等指标比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,pc-CTA评分≤1.5分(OR=0.468,95%CI=0.231~0.946,P=0.035)、pc-CS评分≥4.5分(OR=2.183,95%CI=1.233~3.865,P=0.007)、BATMAN评分≥4.5分(OR=2.461,95%CI=1.320~4.588,P=0.005),均为急性BAO患者血管内治疗后90 d良好临床结局的独立预测因素。受试者工作特征曲线(ROC)分析显示,pc-CS评分、pc-CTA评分、BATMAN评分预测良好临床结局的曲线下面积(AUC)分别为0.766(95%CI=0.632~0.901)、0.814(95%CI=0.697~0.931)、0.869(95%CI=0.763~0.975)。结论pc-CS评分、pc-CTA评分和BATMAN评分均能独立有效地预测血管内治疗急性BAO患者90 d临床结局,其中反映血栓负荷及侧支代偿的BATMAN评分似可更准确地预测预后。Objective To discuss the application of computed tomography angiography(CTA)score in predicting the clinical outcome of patients with acute basilar artery occlusion(BAO)receiving endovascular recanalization within 6-24 hours after onset.Methods The clinical data of 53 consecutive patients with acute BAO,who received endovascular recanalization at the Shengli Oilfield Central Hospital of China between January 2014 and December 2019,were retrospectively analyzed.Based on the modified Rankin scale(mRS)score,the patients were divided into good prognosis group(mRS score≤2 points,n=32)and poor prognosis group(mRS score≥3 points,n=21).The posterior circulation collateral score(pc-CS),posterior circulation computed tomography vascular imaging score(pc-CTA)and basilar artery CTA prognostic score(BATMAN)were used to evaluate the preoperative CTA images.Results There were statistically significant differences in the age,preoperative NIHSS score,discharge NIHSS score,pc-CS,pc-CTA and BATMAN score between the two groups(P<0.05).Multivariate logistic regression analysis showed that pc-CTA score≤1.5 points(OR=0.468,95%CI=0.231-0.946,P=0.035),pc-CS score≥4.5 points(OR=2.183,95%CI=1.233-3.865,P=0.007),and BATMAN score≥4.5 points(OR=2.461,95%CI=1.320-4.588,P=0.005)were the independent predictors for postoperative 90-day good prognosis in acute BAO patients receiving endovascular recanalization.Receiver operating characteristic(ROC)curve analysis indicated that the areas under curve(AUC)of pc-CS score,pc-CTA score and BATMAN score that predicted a good clinical outcome were 0.766(95%CI=0.632-0.901),0.814(95%CI=0.697-0.931)and 0.869(95%CI=0.763-0.975)respectively.Conclusion The pc-CS score,pc-CTA score and BATMAN score can independently predict postoperative 90-day prognosis in acute BAO patients receiving endovascular recanalization.And it seems that BATMAN score,which reflects the thrombosis load and lateral branch compensation,can predict the prognosis more accurately.

关 键 词：急性缺血性脑卒中 基底动脉闭塞 血管内治疗 计算机断层扫描血管成像评分 临床结局 

分 类 号：R743[医药卫生—神经病学与精神病学]