目的 比较直接抽吸技术(a direct aspiration first-pass thrombectomy，ADAPT)和支架取栓(stent retriever thrombectomy，SR)对急性基底动脉闭塞(acute basilar artery occlusion，ABAO)患者的预后及认知的影响。方法 前瞻性纳入神经内科2019年8月—2022年12月间诊断为ABAO患者共90例。根据机械取栓治疗的类型，将患者分为ADAPT组(44例)和SR组(46例)。比较两组患者一般临床资料、手术相关指标、临床预后、不良事件及认知功能。预后评估利用7 d NIHSS评分和90 d mRS评分;认知功能评估利用卒中后6个月MoCA评分;安全性评估利用不良事件发生率和死亡率。采用单因素分析及多因素Logistic回归模型分析影响ABAO患者发生不良临床预后和卒中后认知障碍(post-stroke cognitive impairment，PSCI)的独立危险因素。结果 ADAPT组与SR组患者间的血管成功再通率、术后7 d NIHSS评分、90d 良好结局率(mRS评分≤2分)、6个月后PSCI发生率、不良事件发生率比较，差异均无统计学意义(均P>0。05)。但较SR组，ADAPT组患者的血管再通尝试次数更少，穿刺至血管开通时间和发病至血管再通时间更短(均P<0。05)。多因素Logistic回归分析显示，糖尿病史(OR=18。922，95%CI:2。787～128。474;P=0。003)、基线高NIHSS评分(OR= 1。195，95%CI:1。088～1。316;P=0。000)和低pc-ASPECTS评分(OR=0。298，95%CI:0。154～0。576;P=0。000)是ABAO患者临床预后不良的独立危险因素。高龄(OR=1。150，95%CI:1。034～1。279;P=0。010)、较长的发病至血管再通时间(OR= 1。006，95%CI:1。000～1。012;P=0。035)、基线高NIHSS评分(OR=1。120，95%CI:1。039～1。208;P=0。003)和低pc-ASPECTS评分(OR=0。571，95%CI:0。355～0。918;P=0。021)是ABAO患者发生PSCI的独立危险因素。结论 与SR技术对比，ABAO患者行ADAPT治疗具有相同的临床疗效和安全性，但是行ADAPT可减少再通尝试次数，获得更短的血管开通时间。糖尿病、基线高NIHSS评分和低pc-ASPECTS评分与ABAO患者不良的临床预后独立相关。高龄、较长的发病至血管再通时间、基线高NIHSS评分和低pc-ASPECTS评分与ABAO患者PSCI的发生独立相关。
Comparison of Therapeutic Effects of Direct Aspiration and Stent Thrombec-tomy on Prognosis and Cognitive Function in Patients with Acute Basilar Ar-tery Occlusion
Objective To compare the prognostic and cognitive effects of direct aspiration first-pass thrombectomy(ADAPT)and stent retriever thrombectomy(SR)on patients with acute basilar artery occlusion(ABAO).Methods A total of 90 patients with ABAO from August 2019 to December 2022 in the department of neurology in our hospital were prospectively enrolled.According to the type of throm-bectomy,the patients were divided into ADAPT group(44 cases)and SR group(46 cases).The clinical data,surgery-related indicators,clinical outcome,adverse events,and cognitive function of the two groups were evaluated.The clinical outcome was evaluated with the 7-day NIHSS score and the 90-day mRS score;The cognitive function was analyzed via MoCA score at 6 months after stroke;The safety evaluation was evaluated with the incidence of adverse events and mortality.Univariate analysis and multivariate Logistic regression model were used to analyze the independent risk factors of adverse clinical prognosis and post-stroke cognitive impairment(PSCI)in ABAO patients.Results There were no significant differences in the successful vascular recanalization rate,NIHSS score at 7 days after surgery,good outcome rate at 90 days(mRS Score≤2 points),incidence of PSCI and incidence of adverse events follow-up for 6 months between the ADAPT group and the SR group(all P>0.05).But compared with the SR group,patients in the ADAPT group had lower number of attempts at recanalization,a shorter time from puncture to vascular recanalization,and a shorter time from onset to vascular re-canalization(all P>0.05).Multivariate logistic regression showed that diabetes history(OR=18.922,95%CI:2.787-128.474;P=0.003),baseline high NIHSS scores(OR=1.195,95%CI:1.088-1.316;P=0.000),and low pc-ASPECTS scores(OR=0.298,95%CI:0.154-0.576;P=0.000)were the independent risk factors for poor clinical prognosis in ABAO patients.Advanced age(OR=1.150,95%CI:1.034-1.279;P=0.010),long time from onset to vascular recanalization(OR=1.006,95%CI:1.000-1.012;P=0.035),baseline high NIHSS scores(OR=1.120,95%CI:1.039-1.208;P=0.003)and low pc-ASPECTS scores(OR=0.571,95%CI:0.355-0.918;P=0.021)were the independent risk factors for PSCI in ABAO patients.Conclusion Compared with the SR technique,ADAPT has the same effi-cacy and safety in patients with ABAO.Diabetes,baseline NIHSS scores,and low pc-ASPECTS scores are independent risk factors for the poor outcome in patients with ABAO.Advanced age,prolonged time from onset to vascular recanalization,baseline NIHSS scores,and low pc-ASPECTS scores can independently contribute to the onset of PSCI in patients with ABAO.
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