Objective: To compare the effectiveness of first-line mechanical thrombectomy (MT) with other types of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO). Methods: From May 2012 to December 2019, acute VBAO patients diagnosed by angiographic examinations were consecutively enrolled from Nanjing Stroke Registry. Patients were divided into first-line MT group who were treated with stent retriever and direct aspiration, and other types of EVT group who underwent intraarterial thrombolysis, tirofiban infusion, balloon dilation, and stent placement etc. Clinical characteristics at baseline with statistical trends (P<0.1) between different groups were analyzed to calculate propensity scores, which were adjusted in binary Logistic regression for the relationship between first-line treatment and clinical outcome. Results: A total of 107 patients were enrolled in this study including 82 males and 25 females with average age 62 years old (35-82). The overall recanalization rate was 82.2% (88/107). During follow-up, 33.6% (36/107) and 37.1% (39/105) patients achieved good outcome (defined as modified Rankin Scale score 0-3) at 90 days and 1 year, respectively. The MT group received EVT earlier than the other types of EVT group (median year: 2017 vs. 2015, P=0.017), as well as higher proportion of atrial fibrillation history (21.6% vs. 0, P=0.002), higher baseline National Institution of Health Stroke Scale scores (median: 26 vs. 23, P=0.049), lower Glasgow Coma Scale scores (median: 6 vs. 7, P=0.027), and longer estimated occlusion to groin-puncture time (median: 367 min vs. 283 min, P=0.023). There were significant differences in the stroke etiologies between two groups (P=0.002). The MT group had a lower ratio of rescue device treatment (28.4% vs. 54.5%, P=0.009). After propensity scores were adjusted, the recanalization rate of MT group was significantly higher than that in the other group [odds ratio (95% confidence interval [CI]):5.201, 95%CI 1.562-17.317, P=0.007]. No difference was noted regarding other clinical outcomes. Subgroup analysis indicated that recanalization rates in patients without atherosclerosis were different between intervention types [odds ratio (95%CI): 7.859, 95%CI 1.469-42.042, P=0.016], while the recanalization rates was comparable in population with atherosclerosis [odds ratio (95%CI): 3.739, 95%CI 0.613-22.812, P=0.153]. Conclusion: In acute VBAO patients, first-line MT is associated with higher recanalization rate compared with other types of EVT, especially in non-atherosclerosis patients.
目的： 比较首选机械取栓（MT）和其他类型的血管内治疗（EVT）在急性椎基底动脉闭塞（VBAO）患者中的疗效差异。 方法： 回顾性连续纳入2012年5月至2019年12月南京卒中登记系统中经影像学检查证实的急性VBAO并接受EVT的患者。根据首选EVT方式将患者分为首选MT组（包括可回收支架取栓及直接抽吸取栓）和其他类型EVT组（包括动脉溶栓、动脉内替罗非班、球囊扩张术、支架置入术等），采用t检验、秩和检验、卡方检验及精确概率法对两组患者间特征进行对比，选取两组患者基线资料中存在统计学差异趋势（P<0.1）的变量进行倾向评分的计算，并将倾向评分作为协变量在二元logistic回归方程中进行校正，以分析治疗方式和不同临床结局之间的统计学关联。 结果： 一共纳入107例患者，男性82例、女性25例，年龄38~85岁，平均年龄62岁。总体成功再通率为82.2%（88/107），出院后90 d和1年期良好结局（定义为改良Rankin量表0~3分）比例分别为33.6%（36/107）和37.1%（39/105）。首选MT组患者手术年份晚于其他类型EVT组（中位数：2017年比2015年，P=0.017），房颤病史的比例显著较高（21.6%比0，P=0.002），入院美国国立卫生院卒中量表评分较高（中位数：26比23，P=0.049），格拉斯哥昏迷量表评分较低（中位数：6比7，P=0.027），预估闭塞到穿刺时间较长（中位数：367 min比283 min，P=0.023）。两组患者的卒中病因学分型差异有统计学意义（P=0.002），首选MT组接受器械补救治疗的比例更低（28.4%比54.5%，P=0.009）。校正倾向评分后，首选MT组成功再通率显著高于其他类型EVT组（比值比5.201，95%CI 1.562~17.317，P=0.007），其他临床结局差异无统计学意义。按照病因分型进行的亚组分析结果提示，非大动脉粥样硬化患者首选MT的成功再通率显著高于其他类型EVT组（比值比7.859，95%CI 1.469~42.042，P=0.016），大动脉粥样硬化病因分型中两组患者成功再通率差异无统计学意义（比值比3.739，95%CI 0.613~22.812，P=0.153）。 结论： 在急性VBAO患者中，首选MT的成功再通率显著高于其他类型的EVT，再通差异主要体现在非大动脉粥样硬化患者群体中。两组患者有着相似的90 d和1年期临床结局。.