探讨后循环血管形态改变对急性椎基底动脉闭塞（AVBAO）患者机械取栓临床预后的影响。

回顾性分析2019年1月至2021年7月潍坊市人民医院收治的因AVBAO行机械取栓的74例患者的临床资料。根据患者术中椎基底动脉形态分为血管形态改变组（42例）和血管形态正常组（32例）。比较2组患者的临床资料，采用独立样本t检验比较手术时间、美国国立卫生研究院卒中量表（NIHSS）评分等计量资料的差异，采用Fisher确切概率法比较不良习惯、疾病史和预后等计数资料的差异。

2组患者性别、年龄、发病到取栓时间、术前NIHSS评分、吸烟、饮酒等比较，差异均无统计学意义（P均＞0.05）。血管形态改变组高血压病比例[71.43%（30/42）vs 3.50%（12/32）]、糖尿病比例[69.05%（29/42）vs 31.25%（10/32）]明显高于血管形态正常组，差异具有统计学意义（P=0.005、0.002）；血管形态正常组心源性疾病比例较血管形态改变组明显高[93.75%（30/32）vs 50.00%（21/42）]，差异具有统计学意义（P＜0.001）。2组患者脑动脉再通成功率、血栓逃逸发生率、术后脑出血发生率比较，差异均无统计学意义（P均＞0.05）。与血管形态正常组比较，血管形态改变组患者手术时间长[（82.14±16.97）min vs（68.28±14.57）min]，NIHSS评分差值[（14.12±3.75）分 vs（9.56±3.52）分]、术后死亡率[38.10%（16/42）vs 15.63%（5/32）]、术中替罗非班的使用率[61.90%（26/42）vs 3.13%（1/32）]及支架置入比例[57.14%（24/42）vs 0（0）]均较高，术后90 d良好预后比例较低[11.90%（5/42）vs 34.38%（11/32）]，差异均具有统计学意义（t=3.697，P＜0.001；t=5.317，P＜0.001；P=0.040；P＜0.001；P＜0.001；P=0.025）。

后循环血管形态改变增加了手术复杂性，导致手术时间延长，脑组织长时间缺血缺氧致不可逆损伤，与AVBAO机械取栓临床预后密切相关。

To investigate the influence of morphological changes of posterior circulation vessels on the clinical prognosis of mechanical thrombectomy in acute vertebrobasilar artery occlusion.

The clinical data of 74 patients with acute vertebrobasilar artery occlusion who underwent mechanical thrombectomy in Weifang people's Hospital from January 2019 to July 2021 were analyzed retrospectively. According to the shape of vertebrobasilar artery, the patients were divided into vascular morphology change group (42 cases) and vascular morphology normal group (32 cases). The clinical data of the two groups were compared. The independent samples t-test was used to compare the measurement data of operation time, National Institutes of Health stroke scale (NIHSS) score, and so on; and the Fisher exact probability method was used to compare the count data of bad habits, disease history and prognosis.

There was no significant difference in gender, age, time from onset to thrombectomy, preoperative NIHSS score, smoking, and drinking between the two groups (all P＞0.05). The proportion of hypertension[71.43%(30/42) vs 3.50%(12/32)] and diabetes [69.05%(29/42) vs 31.25%(10/32)] in vascular morphology change group was both significantly higher than that in vascular morphology normal group (P=0.005; P=0.002). The proportion of cardiogenic diseases [93.75%(30/32) vs 50.00%(21/42)] in the vascular morphology normal group was significantly higher than that in the vascular morphology change group (P＜0.001). There was no significant difference in the success rate of cerebral artery recanalization, the incidence of thrombus escape and the incidence of postoperative intracerebral hemorrhage between the two groups (all P＞0.05). Compare to vascular morphology normal group, the operation time [(82.14±16.97) min vs (68.28±14.57) min], NIHSS score difference [14.12±3.75 vs 9.56±3.52], postoperative mortality [38.10%(16/42) vs 15.63%(5/32)], the utilization rate of Tirofiban [61.90%(26/42) vs 3.13%(1/32)], and the proportion of stent implantation [57.14%(24/42) vs 0%(0)] were higher than that in vascular morphology change group; the proportion of good prognosis 90 days after operation was lower [11.90%(5/42) vs 34.38%(11/32)] than that in vascular morphology change group. There were statistically significant difference between the two groups (t=3.697, P＜0.001; t=5.317, P=0.004; P＜0.001; P＜0.001; P=0.025).

Due to the morphological changes , the complexity of operation lead to the prolonged operation time. Long-term ischemia and hypoxia cause irreversible cerebral damage. The morphological changes of posterior circulation vessels are closely related to the clinical prognosis of mechanical thrombectomy in acute vertebrobasilar artery occlusion.