Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment

Wang, Jinjing; Zhu, Shuanggen; Xu, Pengfei; Huang, Xianjun; Liu, Chaolai; Liu, Dezhi; Xiao, Lulu; Gu, Mengmeng; Cai, Qiankun; Tao, Chunrong; Li, Shizhan; Wang, Qizhang; Lan, Wenya; Sun, Wen; Liu, Xinfeng

doi:10.1007/s00415-022-11218-4

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…The retrospective PERSIST recruited stroke centers within China to submit demographic, clinical presentation, procedural details, angiographic and clinical outcome data on consecutive patients who present with acute, symptomatic, radiologically verified VBAO treated with EVT at 21 stroke centers from Dec 2015 to Dec 2018 (Registration: URL: http://www.chictr.org.cn/ ; Unique identifier: ChiCTR2000033211). Previously published work described PERSIST methodology in detail ( 10 , 11 ).…”

Section: Methodsmentioning

confidence: 99%

General anesthesia vs. non-general anesthesia for vertebrobasilar stroke endovascular therapy

Xu²,

Wang³

et al. 2023

Front. Neurol.

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BackgroundThe optimal type of anesthesia for acute vertebrobasilar artery occlusion (VBAO) remains controversial. We aimed to assess the influence of anesthetic management on the outcomes in VBAO patients received endovascular treatment (EVT).MethodsPatients underwent EVT for acute VBAO at 21 stroke centers in China were retrospectively enrolled and compared between the general anesthesia (GA) group and non-GA group. The primary outcome was the favorable outcome, defined as a modified Rankin Scale (mRS) score 0–3 at 90 days. Secondary outcomes included functional independence (90-day mRS score 0–2), and the rate of successful reperfusion. The safety outcomes included all-cause mortality at 90 days, the occurrence of any procedural complication, and the rate of symptomatic intracranial hemorrhage (sICH). In addition, we performed analyses of the outcomes in subgroups that were defined by Glasgow Coma Scale (GCS) score (≤8 or >8).ResultsIn the propensity score matched cohort, there were no difference in the primary outcome, secondary outcomes and safety outcomes between the two groups. Among patients with a GCS score of 8 or less, the proportion of successful reperfusion was significantly higher in the GA group than the non-GA group (aOR, 3.57, 95% CI 1.06–12.50, p = 0.04). In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar results were found.ConclusionsPatients placed under GA during EVT for VBAO appear to be as effective and safe as non-GA. Furthermore, GA might yield better successful reperfusion for worse presenting GCS score (≤8).RegistrationURL: http://www.chictr.org.cn/; Unique identifier: ChiCTR2000033211.

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Section: Methodsmentioning

confidence: 99%

General anesthesia vs. non-general anesthesia for vertebrobasilar stroke endovascular therapy

Xu²,

Wang³

et al. 2023

Front. Neurol.

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“…The PERSIST is a retrospective registered trial conducted in 21 stroke centers in China from December 2015 to December 2018, which consecutively collected patients with acute VBAO received EVT treatment. Inclusion and exclusion criteria have been described in detail in previous studies ( 13 , 14 ). The inclusion criteria were as follows: 1) aged 18 years or older; 2) with acute symptomatic VBAO confirmed by imaging examination (including computed tomography angiography, magnetic resonance angiography or digital subtraction angiography); 3) treated with EVT within 24 hours (estimated occlusion to groin puncture time).…”

Section: Methodsmentioning

confidence: 99%

Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion

Jin²,

et al. 2022

Front. Endocrinol.

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ObjectiveEndovascular treatment (EVT) is, to date, the most promising treatment of vertebrobasilar artery occlusion (VBAO). The study aimed to determine the influence of perioperative glucose levels on clinical outcomes in patients with acute VBAO treated with EVT.MethodsWe retrospectively collected consecutive VBAO patients received EVT in 21 stroke centers in China. The associations between perioperative glycemic indicators (including fasting blood glucose[FBG], admission hyperglycemia, stress hyperglycemia ratio [SHR] and short-term glycemic variability [GV]) and various clinical outcomes were analyzed in all patients and subgroups stratified by diabetes mellitus (DM).ResultsA total of 569 patients were enrolled. Admission hyperglycemia significantly correlated with increased risk of symptomatic intracranial hemorrhage (sICH) (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.40-7.46), poor functional outcomes at 90 days (OR 1.91, 95%CI: 1.15-3.18) and 1 year (OR 1.96, 95%CI: 1.20-3.22). Similar significant correlations exist between FBG, SHR, GV and all the adverse outcomes except higher levels GV was not associated with increased risk of sICH (OR 1.04, 95% CI: 0.97-1.12). Subgroup analyses showed that admission hyperglycemia, FBG and SHR were significantly associated with adverse outcomes in non-diabetic patients, but not in DM patients. While, GV was associated with poor functional outcomes regardless of diabetes history.ConclusionsAdmission hyperglycemia, FBG, SHR and short-term GV in VBAO patients treated with EVT were associated with adverse outcomes. The results suggested that comprehensive evaluation and appropriate management of perioperative glucose might be important for patients with VBAO and treatment with EVT.

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“…The PERSIST database is a retrospective registry of patients with acute VBAO who underwent EVT within 24 hours of estimated occlusion time (EOT) between December 2015 and December 2018 at 21 stroke centers in 13 provinces of China (http://www.chictr.org.cn/; unique identifier: ChiCTR2000033211). Details of the PERSIST study have been described previously 9–11. In this study, we further excluded 17 patients with missing data from routine blood examinations prior to EVT.…”

Section: Methodsmentioning

confidence: 99%

“…The follow-up protocol was also published previously 9–11. The primary outcome was unfavorable outcome (modified Rankin Scale (mRS) score of 4–6) at 90 days after EVT.…”

Section: Methodsmentioning

confidence: 99%

Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry

Zhang

Duan

et al. 2022

J NeuroIntervent Surg

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BackgroundFew studies have focused on the effect of systemic inflammation in vertebrobasilar artery occlusion (VBAO). The aim of this study was to investigate the relationship between inflammatory indicators and the prognosis of VBAO patients receiving endovascular treatment (EVT).MethodPatients with VBAO who were treated with EVT within 24 hours of the estimated occlusion time were included in this study. Multivariate logistic regression and elastic net regularization were performed to analyze the effects of inflammatory indicators on the prognosis of patients with VBAO. The primary outcome was unfavorable outcome (a modified Rankin Scale score of 4–6) at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage, in-hospital mortality, 90 day mortality, 1 year unfavorable outcome, and mortality.Results560 patients were included in the study. Multivariate analysis showed that white blood cells (W), neutrophils (N), neutrophil to lymphocyte ratio (NLR), platelet to neutrophil ratio, platelet to white blood cell ratio, and NLR to platelet ratio were associated with the primary outcome. Elastic net regularization indicated that W, N, and NLR were the major inflammatory predictors of unfavorable outcome at 90 days. For long term prognosis, we found that the inflammatory indicators that predicted 1 year outcomes were consistent with those that predicted 90 day outcomes.ConclusionInflammatory indicators, especially W, N, and NLR, were associated with moderate and long term prognosis of patients with VBAO treated with EVT.

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Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment

Cited by 5 publications

References 29 publications

General anesthesia vs. non-general anesthesia for vertebrobasilar stroke endovascular therapy

General anesthesia vs. non-general anesthesia for vertebrobasilar stroke endovascular therapy

Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion

Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry

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