切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 360 -365. doi: 10.11817/j.issn.1673-9248.2022.05.014

综述

急性基底动脉闭塞血管内治疗的研究进展
陈东升1, 张萌2, 张彩兰3, 孙支唐1,()   
  1. 1. 030001 太原,山西医科大学第二医院神经内科
    2. 710061 西安,西安交通大学第一附属医院神经内科
    3. 030001 太原,山西医科大学第二医院呼吸内科
  • 收稿日期:2022-06-27 出版日期:2022-10-01
  • 通信作者: 孙支唐
  • 基金资助:
    国家自然科学基金青年项目(81801122); 陕西省自然科学基础研究青年项目(2020JQ-529)

Research progress in the endovascular treatment of acute basil artery occlusion

Dongsheng Chen1, Meng Zhang2, Cailan Zhang3, Zhitang Sun1,()   

  1. 1. Department of Neurology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
    2. Department of Neurology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
    3. Department of Respiratory Medicine, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2022-06-27 Published:2022-10-01
  • Corresponding author: Zhitang Sun
引用本文:

陈东升, 张萌, 张彩兰, 孙支唐. 急性基底动脉闭塞血管内治疗的研究进展[J]. 中华脑血管病杂志(电子版), 2022, 16(05): 360-365.

Dongsheng Chen, Meng Zhang, Cailan Zhang, Zhitang Sun. Research progress in the endovascular treatment of acute basil artery occlusion[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(05): 360-365.

急性基底动脉闭塞(ABAO)是椎-基底动脉系统缺血性卒中的重要原因,致残率及致死率约为90%,疾病负担沉重。最近的研究表明,ABAO患者治疗成功的关键在于尽早实现有效再灌注,挽救缺血半暗带。但ABAO患者行血管内治疗(EVT)尚缺乏循证医学证据支持。因此,本文对ABAO患者多中心、前瞻性、随机、对照的EVT试验进行综述,比较不同EVT方式对于ABAO患者的远期疗效,并分析术前的影像学评估与ABAO患者转归的关系,旨在为临床ABAO患者行EVT提供指导和参考。

Acute basilar artery occlusion (ABAO) is one of the key causes of ischemic strokes in the vertebrobasilar system, with a high disability and mortality of about 90% and therefore a heavy disease burden. Recent studies indicate that the key to successful treatment of ABAO is to start reperfusion therapy as soon as possible and to save the ischemic penumbra by endovascular treatment (EVT). However, EVT for ABAO is still lack of evidence-based medicine. Hence, we summarize the progress in EVT by comparing different EVTs and analyzing the correlation between preoperative imaging elvaluation and clinical outcome, so as to provide reference for clinical EVT of patients.

表1 各种影像学评估量表的数据比较
1
Ye GF, Lu J, Qi P, et al. Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis [J]. Neurointerv Surg, 2019, 11(8): 740-746.
2
Writing Group for the BASILAR Group, Zi W, Qiu Z, et al. Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry [J]. JAMA Neurol, 2020, 77(5): 561-573.
3
缪中荣, 霍晓川. 未来已来: 急性缺血性卒中血管内治疗中国现状 [J]. 中国卒中杂志, 2021, 16(11): 1085-1090.
4
高峰, 徐安定. 急性缺血性卒中血管内治疗中国指南2015 [J]. 中国卒中杂志, 2015, 10(7): 590-606.
5
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2019, 50(12): e344-e418.
6
Chang KC, Chuang IC, Huang YC, et al. Risk factors outperform intracranial large artery steno -sis predicting unfavorable outcomes in patients with stroke [J]. BMC Neurol, 2019, 19(1): 180.
7
Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, et al. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation [J]. Neurointerv Surg, 2019, 11(12): 1174-1180.
8
Weber R, Minnerup J, Nordmeyer H, et al. Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry [J]. Eur J Neurol, 2019, 26(2): 299-305.
9
Wang FZ, Wang JQ, He Q, et al. Mechanical thrombectomy for posterior circulation occlusion: a comparison of outcomes with the anterior circulation occlusion meta analysis [J]. Atheroscler Thromb, 2020, 27(12): 1325-1339.
10
Kumar G, Shahripour RB, Alexandrov AV, Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis [J].Neurointerv Surg, 2015, 7(12): 868-874.
11
Fisher M. Endovascular therapy for basilar-artery occlusion-still waiting for answers [J]. N Engl J Med, 2021, 384(20): 1954-1955.
12
Caplan LR, Wityk RJ, Pazdera L, et al. New England Medical Center Posterior Circulation Stroke Registry Ⅱ. Vascular Lesions [J]. J Clin Neurol, 2005, 1(1): 31-49.
13
Caplan LR, Chung CS, Wityk RJ, et al. New England Medical Center Posterior Circulation Stroke Registry: Ⅰ. Methods, database, distribution of brain lesions, stroke mechanisms, and outcomes [J]. J Clin Neurol, 2005, 1(1): 14-30.
14
Cohen JE, Leker RR, Gomori JM, et al. Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke [J]. J Clin Neurosci, 2016, 34: 70-76.
15
Levy EI, Hanel RA, Boulos AS, et al. Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery [J]. J Neurosurg, 2003, 99(4): 653-660.
16
Yoon W, Kim SK, Park MS, et al. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke [J]. Neurosurgery, 2015, 76(6): 680-686.
17
Ramgren B, Frid P, Norrving B, et al. Endovascular therapy in basilar artery occlusion in Sweden 2016-2019—a nationwide, prospective registry study [J]. Neuroradiology, 2022, 64(5): 959-968.
18
Kasner SE, Gorelick PB. Blue Books of Practical Neurology: Prevention and treatment of ischemic stroke [M]. Oxford, United Kingdom: Butterworth-Heinemann, 2004:1-3.
19
Mullen MT, Pisapia JM, Tilwa S, et al. Systematic review of outcome after ischemic stroke due to anterior circulation occlusion treated with intravenous intraarterial or combind intravenous intraarterial thrombolysis [J]. Stroke, 2012, 43(9): 2350-2355.
20
Schonewhile WJ, Wijman CA, Michel P, et al; BASICS Study Group. Treatment and outcomes of acute basiar artery occlusion in Basiar Artery International Cooperation Study (BASICS): a prospective registry study [J]. Lancet Neurol, 2009, 8(8): 724-730.
21
Lindsberg PJ, Pekkola J, Strbian D, et al. Time window for recanalization in basilar artery occlusion: Speculative synthesis [J]. Neurology, 2015, 85(20): 1806-1815.
22
Burns JD, Rindler RS, Carr C, et al. Delay in diagnosis of basilar artery stroke [J]. Neurocrit Care, 2016, 24(2): 172-179.
23
中国卒中学会, 中国卒中学会神经介入分会, 中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018 [J]. 中国卒中杂志, 2018, 13(7): 706-729.
24
Singer OC, Berkefeld J, Nolte CH, et al; ENDOSTROKE Study Group. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study [J]. Ann Neurol, 2015, 77(3): 415-424.
25
Langezaal LCM, van der Hoeven EJRJ, Mont'Alverne FJA, et al. Endovascular therapy for stroke due to basilar-artery occlusion [J]. N Engl J Med, 2021, 384(20): 1910-1920.
26
Liu XF, Dai QL, Ye RD, et al; BEST Trial Investigators. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial [J]. Lancet Neurol, 2020, 19(2): 115-122.
27
Tao CR, Li R, Zhu YY, et al. Endovascular treatment for acute basilar artery occlusion: A multicenter randomized controlled trial (ATTENTION) [J]. Int J Stroke, 2022, 17(7):815-819.
28
Gao F, Lo WT, Sun X, et al. Combined use of mechanical thrombectomy with angioplasty and stenting for acute basilar occlusions with underlying severe intracranial vertebrobasilar stenosis: preliminary experience from a single chinese center [J]. AJNR Am J Neuroradiol, 2015, 36(10): 1947-1952.
29
Luo G, Gao F, Zhang XL, et al. Intracranial stenting as rescue therapy after failue of mech- anical thrombectomy for basilar artery occlusion: data from the ANGEL-ACT registry [J]. Front Neurol, 2021, 12: 739213.
30
杨营营, 李明利, 徐蔚海. 高分辨磁共振成像在基底动脉粥样硬化性疾病中的临床应用 [J]. 中国卒中杂志, 2017, 12(4): 370-374.
31
Cao J, Xuan J, Chen R, et al. Intra arterial treatment for patients with severe acute vertebrobasilar occlusion: a single-center retrospective study [J]. J Stroke Cerebrovasc Dis, 2017, 26(10): 2376-2382.
32
Fischer U, Kaesmacher J, Mendes PV, et al. Direct mechanical thrombectomy versus combined intravenous and mechanical thrombectomy in large-artery anterior circulation stroke: a topical review [J]. Stroke, 2017, 48(10): 2912-2918.
33
Jauch EC, Saver JL, Adams HJ, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2013, 44(3): 870-947.
34
Maingard J, Shvarts Y, Motyer R, et al. Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke [J]. Intern Med J, 2019, 49(3): 345-351.
35
Nie X, Wang D, Pu Y, et al. Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion [J]. Stroke Vasc Neurol, 2022, 7(3): 190-199.
36
Siow I, Tan BYQ, Lee KS, et al. Bridging thrombolysis versus direct mechanical thrombectomy in stroke due to basilar artery occlusion [J]. Stroke, 2022, 24(1): 128-137.
37
张东焕, 张保朝, 高军, 等. 桥接法与直接取栓法治疗急性后循环缺血性卒中的疗效比较及预后影响因素分析 [J]. 中华解剖与临床杂志, 2021, 26(3): 293-297.
38
沈红健, 沈芳, 尹伟, 等. 基于CT灌注成像的pc-ASPECTS对椎基底动脉闭塞急性缺血性脑卒中预后的预测价值 [J]. 第二军医大学学报, 2022, 43(1): 42-48.
39
高军, 温昌明, 孙军, 等. 基于CTA的后循环ASPECT评分对急性椎基底动脉闭塞患者血管内治疗临床结局的预测作用 [J]. 中华解剖与临床杂志, 2021, 26 (4): 425-430.
40
Tei HK, Uchiyama SC, Usui TR, et al. Posterior circulation ASPECTS on diffusion weighted MRI can be a powerful marker for predicting functional outcome [J]. J Neurol, 2010, 257(5): 767-773.
41
杨海华, 马宁, 刘恋, 等. 急性基底动脉闭塞血管内治疗不良结局的影响因素分析 [J]. 中国现代神经疾病杂志, 2020, 20(5): 399-406.
42
Jiang CC, Fan Y, Li YC, et al. Predictors of favorable outcomes for vertebrobasilar artery occlusion after endovascular therapy within 24 hours of symptom onset [J]. Clin Neurol Neurosurg, 2021, 201: 106422.
43
Berndt MT, Pree D, Kaesmacher J, et al. From perviousness to plaque imaging in acute basilar occlusions: the impact of underlying stenosis and how to detect it [J]. Stroke, 2020, 51(3): 766-774.
44
Hong JM, Choi JY, Lee JH, et al. Impact of posterior communicating artery on basilar artery steno-occlusive disease [J]. J Neurol Neurosurg Psychiatry, 2009, 80(12): 1390-1393.
45
Nie X, Pu YH, Zhang Z, et al. Futile recanalization after endovascular therapy in acute ischemic stroke [J]. Biomed Res Int, 2018, 2018: 5879548.
46
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022 [J]. 中华神经科杂志, 2022, 55(6): 565-580.
47
侯志文, 张圣, 史宗杰, 等. 急性基底动脉闭塞血管内治疗前影像评估与临床预后相关性的研究进展 [J]. 中华神经医学杂志, 2019, 18(10): 991-995.
48
Da Ros V, Meschini A, Gandini R, et al. Proposal for a vascular computed tomography-based grading system in posterior circulation stroke: a single-center experience [J]. J Stroke Cerebrovasc Dis, 2016, 25(2): 368-377.
49
Filep RC, Marginean L, Stoian A, et al. Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review) [J]. Exp Ther Med, 2021, 22(3): 954.
50
佟旭, 孙瑄, 王伊龙, 等. 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 [J]. 中华放射学杂志, 2021, 55(2): 173-179.
51
Tong X, An JY, Sun X, et al. A pre-intervention 4-item scale for predicting poor outcome despite successful recanalization in basilar artery occlusion [J]. Transl Stroke Res, 2020, 11(6): 1306 - 1313.
[1] 凌海平, 那世杰, 刘涛, 庄宗, 张玉华, 张庆荣, 杭春华. 支架辅助弹簧圈栓塞治疗血泡样动脉瘤的临床疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(05): 263-267.
[2] 徐志嘉, 贾振宇, 赵林波, 刘圣, 施海彬, 曹月洲. 高敏肌钙蛋白T动态变化在晚时间窗内进行血管内治疗的急性缺血性脑卒中患者中的预测价值[J]. 中华介入放射学电子杂志, 2023, 11(01): 42-47.
[3] 赖和泰, 刘羽, 程光森, 刘永康, 李忠亮, 陆骊工. 39例Surpass Streamline治疗未破裂动脉瘤患者诊疗分析:单中心临床经验[J]. 中华介入放射学电子杂志, 2023, 11(01): 19-24.
[4] 梁欣, 刘兰祥. 急性缺血性脑卒中柔脑膜侧支循环的评估方法[J]. 中华介入放射学电子杂志, 2022, 10(02): 196-201.
[5] 孙世蒙, 李天晓, 李立, 邵秋季, 常凯涛, 吴桥伟. 国产Tubridge血流导向装置治疗椎动脉夹层动脉瘤的初步应用[J]. 中华介入放射学电子杂志, 2021, 09(02): 160-164.
[6] 杭宇, 贾振宇, 曹月洲, 赵林波, 黄璜, 栾丽芹, 施海彬, 刘圣. 分级转运与会诊治疗模式对急性大血管闭塞性脑卒中血管内治疗效率与疗效的影响[J]. 中华介入放射学电子杂志, 2021, 09(02): 155-159.
[7] 罗瀚, 袁亚君, 敖峰, 陈中国, 刘汉伟. Neuroform EZ在重度症状性颅内动脉粥样硬化性狭窄血管内治疗中的疗效评价[J]. 中华介入放射学电子杂志, 2021, 09(01): 45-51.
[8] 王俊杰, 尹晓亮, 刘二腾, 陆军, 祁鹏, 胡深, 杨希孟, 陈鲲鹏, 张东, 王大明. 机器学习对预测颈内动脉非急性闭塞患者血管内再通术成功的潜在价值[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 464-470.
[9] 孙洪扬, 刘基, 龚字翔, 王广英, 宁召腾, 赵璇, 朱其义, 王贤军. 急性前循环大血管闭塞性轻型卒中血管内治疗的临床预后及手术时机选择[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 445-451.
[10] 袁兴运, 陈万红, 鱼丽萍, 姚力. 以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 394-399.
[11] 杜小林, 陈鄂, 康俊龙, 肖庆, 丰伟, 田新华. 椎-基底动脉夹层动脉瘤介入治疗的疗效分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 350-358.
[12] 黎丹丹, 程峙娟, 刘旭, 陈未平, 殷敏, 郭华, 涂江龙. 急性后循环进展性缺血性卒中患者血管内治疗的效果[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 112-123.
[13] 张文胜, 幸伟芳, 谢颖, 何锦照. 急性前循环大血管闭塞血管内治疗头颅CT高密度影的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 159-162.
[14] 钱锦宏, 吴建东, 丁志良, 董晓峰, 唐晓宇, 马冕, 邓朋. 慢性症状性颈内动脉闭塞开通的初步探索[J]. 中华脑血管病杂志(电子版), 2022, 16(06): 416-421.
[15] 彭涛, 张紫霓, 朱碧峰, 但毕堂. 前循环串联病变血管内治疗预后的影响因素分析[J]. 中华脑血管病杂志(电子版), 2021, 15(05): 319-322.
阅读次数
全文


摘要