Effect of procedure time on the outcome and symptomatic intracranial hemorrhage of patients with acute vertebrobasilar artery occlusion underwent endovascular mechanical thrombectomy
10.3760/cma.j.issn.1673-4165.2024.12.004
- VernacularTitle:手术操作时间对血管内机械血栓切除术治疗的急性椎基底动脉闭塞患者转归和有症状颅内出血的影响
- Author:
Ruyue WANG
1
;
Miaomiao HU
;
Yingjie XU
;
Pan ZHANG
;
Wen SUN
Author Information
1. 蚌埠医科大学研究生院，蚌埠 233030
- Keywords:
Ischemic stroke;
Vertebrobasilar insufficiency;
Endovascular procedures;
Thrombectomy;
Treatment outcome;
Intracranial hemorrhages;
Time factor
- From:
International Journal of Cerebrovascular Diseases
2024;32(12):901-905
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To investigate the relationship between procedure time (PT) and outcome in patients with acute vertebrobasilar artery occlusion (VBAO) underwent endovascular mechanical thrombectomy (EMT), and to evaluate whether symptomatic intracranial hemorrhage (sICH) plays a mediating role in this relationship.Methods:Patients with acute VBAO underwent EMT treatment at 65 comprehensive stroke centers in 15 provinces of China from December 2015 to June 2022 were included retrospectively. PT was defined as the time from puncture to the first successful recanalization or termination of procedure (if recanalization was not successful). The main outcome measure was the functional outcome evaluated using the modified Rankin Scale at 90 days after onset, 0-3 was defined as good outcome and >3 was defined as poor outcome. The secondary outcome measure was sICH. Multivariate logistic regression analysis was used to determine the independent influencing factors of functional outcome and sICH. Mediation analysis was use to determine whether sICH affected the association between PT and functional outcome. Results:A total of 2 353 patients with acute VBAO underwent EMT treatment were enrolled, including 1 764 males (71.1%), aged 64.0±12.2 years. The baseline National Institutes of Health Stroke Scale score was 21.16±10.03 (median 22, interquartile range, 13-28), the baseline posterior circulation Alberta Stroke Project Early CT Score was 8.36±1.56 (median 8, interquartile range 7-10), and the baseline Basal Artery CT Angiography Score was 5.15±2.52 (median 5, interquartile range, 3-7). One hundred and sixty-nine patients (7.2%) had sICH; 1 061 (45.1%) had good outcome, while 1 292 (54.9%) had poor outcome. Multivariate logistic regression analysis showed that a longer PT was significantly independently associated with the poor outcome at 90 days (odds ratio 1.238, 95% confidence interval 1.144-1.340; P<0.001), but not independently associated with sICH. The mediation effect analysis showed that longer PT did not directly increase the risk of sICH ( P=0.077), and the explanation of sICH for the association between PT and poor outcome was limited. This suggested that a longer PT also promote the poor outcome through other pathways, such as ischemic injury. Conclusion:Longer PT is an independent predictor of poor outcome in patients with acute VBAO at 90 days after EMT, and sICH is not the main mediating factor for poor outcome caused by longer PT.
