Comparative Study Between Endovascular Treatment And Conservative Treatment In Patients With Acute Basilar Artery Occlusion

Objective:1.To compare the efficacy and safety of endovascular treatment and conservative treatment in patients with acute basilar artery occlusion.2.To analyze the influence factors of the two treatment schemes on the clinical prognosis of patients.Materials and Methods:Eighty-three patients with acute basilar artery occlusion confirmed by DSA,CTA or MRA in the The First Affiliated Hospital of Dalian Medical Universityfrom January2017 to December 2022 were retrospectively collected,after the relevant demographic clinical data of all patients were extracted,they were divided into endovascular treatment group and conservative treatmentgroup according to treatment methods,and the efficacy and safety of the two treatment methods were compared.Short-term efficacy assessment indicators included whether there was early neurological deterioration(END),14 d National Institutes of Health Stroke Scale(NIHSS)score,absolute and percentage changes in NIHSS score.Long-term efficacy was assessed by 90 d modified Rankin score(m RS).Safety measures included the rate of hemorrhage conversion,the rate of symptomatic intracranial hemorrhage,and 90-day mortality.Further,the endovascular treatment group and the conservative treatment group were divided into the good prognosis group(m RS≤3 points)and the poor prognosis group(m RS > 3points)according to the 90 dm RS score,respectively.Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of the two treatment plans on the clinical prognosis of patients.Results:1.A total of 83 patients with acute basilar artery occlusion were collected in this study,including 39 patients in the endovascular treatment group and 44 patients in the conservativetreatment group.There was no statistical difference in baseline indicators between the two groups.The incidence of END in the two groups was 17.9%(7/39)and22.7%(10/44),respectively,with no significant difference(P=0.590).Comparison of14 d NIHSS between the two groups: 14 d NIHSS score of the endovascular treatment group was 20.00(15.00,24.00),and 14 d NIHSS score of the conservative treatment group was 15.50(13.00,23.75),P=0.317.There was no statistical difference between the two groups.The absolute value change of 14 d NIHSS and the percentage of absolute value change of 14 d NIHSS(%)of the two groups showed that P=0.117 in the former group and P=0.136 in the latter group,showing no statistical significance.The long-term good prognosis(m RS: 0-3)of the two groups was compared: 10 cases(25.6%)in the endovascular treatment group and 11 cases(25.0%)in the conservative treatment group(P=0.575),and there was no statistical difference between the two groups.Comparison of safety between the two groups: the incidence rate of hemorrhage conversion was 23.1% and 4.5%,respectively,P=0.013;The incidence of symptomatic intracranial hemorrhage was 12.8% and 0,P=0.047,with statistical differences.The 90 d mortality rates of the two groups were 33.3% and 27.3%,respectively(P=0.548),showing no statistical difference.2.Patients with acute basilar artery occlusion were divided into 10 patients with good prognosis(≤3 points)and 29 patients with poor prognosis(> 3 points).Univariate analysis showed that gender,age,smoking history,previous history,blood pressure level,baseline blood glucose,homocysteine,blood lipid level(cholesterol,triglycerides,low density lipoprotein,high density lipoprotein),urea nitrogen/creatinine,white blood cell count,platelet,hemoglobin,INR,fibrinogen,intravenous thrombolysis status,and basilar artery closure site in both groups,thrombus removal times,time from onset to vascular recanalization,m TICI grading and ACGS-BAO score had no statistical significance,while neutrophil/lymphocyte ratio,NIHSS score on admission,time from femoral artery puncture to vascular recanalization and TOAST classification had statistical significance(P< 0.05).The above risk factors with P< 0.1 were included into the binary logistic regression analysis model.The TOAST classification was cardiogenicembolism(OR=18.919,95%CI:1.230～290.918,P=0.035),andthe ACGS-BAO score ≤ grade 2 was poor collateral circulation(OR=0.082,95%CI :0.007～0.990,P=0.049)was an independent risk factor for poor prognosis in patients treated with acute basilar artery occlusion.3.Patients with acute basilar artery occlusion were divided into 11 patients with good prognosis(≤3 points)and 33 patients with poor prognosis(> 3 points).Univariate analysis showed differences in gender,age,smoking history,previous history,blood pressure,baseline blood glucose,homocysteine,lipid levels(cholesterol,triglycerides,low density lipoprotein,high density lipoprotein),white blood cell count,neutrophil/lymphocyte ratio,platelet,hemoglobin,INR,fibrinogen,and intravenous thrombolysis There was no statistical significance,but there were statistically significant differences in blood urea nitrogen/creatinine,NIHSS score on admission and TOAST classification(P < 0.05).The above risk factors with P< 0.1,blood urea nitrogen/creatinine,admission NIHSS score and TOAST score,were included into the binary logistic regression analysis model,and it was found that the admission NIHSS score was higher(OR=2.529,95%CI:1.033～6.196,P=0.042)is an independent risk factor for poor prognosis in patients with acute basilar artery occlusion treated with conservative drugs.Conclusions:1.For patients with acute basilar artery occlusion,there was no significant difference in the near and long-term efficacy between endovascular treatment and conservative treatment.In terms of safety,although the risk of intracranial hemorrhage conversion and symptomatic intracranial hemorrhage conversion was higher in the endovascular treatment group than in the conservative treatment group,there was no increased risk of death within 90 days.2.Cardiogenic embolism and poor collateral circulation may be independent risk factors for poor prognosis at 90 days in patients treated endovascularly with acute basilar artery occlusion.3.Higher admission NIHSS score may be an independent risk factor for poor prognosis at 90 days in patients treated conservatively with acute basilar artery occlusion.