Safety and efficacy of early endovascular therapy combined with butylphthalide for acute basilar artery occlusion: a multicenter, prospective cohort study

Di-san junyi daxue xuebao

ZI Wenjie¹  LI Fengli¹  YUAN Junjie¹  QIU Zhongming²  LIU Shuai²  YUE Feixue²  SANG Hongfe²  LIU Hansheng²  LUO Weidong² 

[1] ;Department of Neurology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037;

关键词: acute basilar artery occlusion;    endovascular therapy;    butylphthalide;   

DOI  :  10.16016/j.1000-5404.202008058

来源: DOAJ

【 摘 要 】

Objective To investigate the efficacy and safety of early endovascular therapy (EVT) combined with butylphthalide (NBP) in the patients with acute basilar artery occlusion (BAO). Methods From January 2014 to May 2019, 645 acute BAO patients (from the Second Affiliated Hospital of Army Medical University and other 46 comprehensive stroke centers in China) who underwent EVT were enrolled into this study. According to receiving NBP treatment or not, the patients were divided into simple EVT group (control group, n=413) and EVT+NBP group (NBP group, n=232). Safety and efficacy were evaluated and compared between the 2 groups, with symptomatic intracerebral hemorrhage (sICH) within 48 h and 90-day all cause mortality as evaluation criteria for safety, and the modified Rankin Scale (mRS) score and the modified Thrombolysis in Cerebral Infarction (mTICI) for efficacy. Binary Logistic regression was used for multi-factor analysis, with calibration factors of age, blood pressure, time from onset to puncture, mTICI grade, diabetes mellitus, baseline NIHSS score, pc-ASPECTS score, ASITN/SIR grade and occlusion sites, etc. Results At 90 d after treatment, the NBP group had a higher rate of mRS low score (≤3) than the control group [39.2% (91/232) vs 28.1% (116/413), Chi-square=8.454, P=0.005], indicating better functional prognosis. The incidence of sICH [1.7% (4/232) vs 10.2% (41/403), Chi-square=15.965, P < 0.001] and 90-day mortality [34.1% (79/232) vs 52.8% (218/413), Chi-square=20.983, P < 0.001] were both significantly lower in the NBP group when compared to the control group. Logistic regression analysis indicated that NBP was an independent protective factor for good functional prognosis at 90 d (OR=1.646, 95%CI: 1.091~2.483, P=0.018), reduced incidence of sICH (OR=0.164, 95%CI: 0.056~0.475, P=0.001) and lower mortality at 90 d (OR=0.424, 95%CI: 0.278~0.647, P < 0.001). Conclusion Early EVT combined with NBP can significantly improve the 90-day functional prognosis, and reduce the sICH risk and mortality in the acute BAO patients.

【 授权许可】

Unknown