ABSTRACT
OBJECTIVE: We aimed to investigate the effectiveness of endovascular therapy (EVT) versus intravenous thrombolysis (IVT) in patients with basilar artery occlusion (BAO), based on the information of advanced imaging. METHODS: We analyzed data of stroke patients with radiologically confirmed BAO within 24 hours. BAO subjects were categorized into "top-of-the-basilar" syndrome (TOBS) and other types. An initial infarct size of <70ml and a ratio of ischemic tissue to infarct volume of ≥1.8 was defined as "target mismatch." The primary outcome was a good outcome, defined as a modified Rankin Scale score of 0 to 3 at 3 months. Propensity score adjustment and inverse probability of treatment weighting (IPTW) propensity score methods were used. RESULTS: Among 474 BAO patients, 93 (19.6%) were treated with IVT prior to EVT, 91 (19.2%) were treated with IVT alone, 95 (20.0%) were treated with EVT alone, and 195 (41.1%) were treated with antithrombotic therapy. In IPTW analyses, we found no benefit of EVT over IVT for good outcome in either TOBS patients (odds ratio = 1.08, 95% confidence interval [CI] = 0.88-1.31) or those with other types (odds ratio = 1.13, 95% CI = 0.94-1.36). However, in patients with other types, if there existed a target mismatch, EVT was independently related to good outcome (odds ratio = 1.46, 95% CI = 1.17-1.81). INTERPRETATION: The "target mismatch profile" seems to be a possible candidate selection standard of EVT for those with other types of BAO. Future studies should separate TOBS from other types of BAO, and try to use advanced imaging. ANN NEUROL 2022;92:97-106.
Subject(s)
Arterial Occlusive Diseases , Endovascular Procedures , Stroke , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/therapy , Basilar Artery/diagnostic imaging , Endovascular Procedures/methods , Humans , Infarction , Reperfusion , Stroke/diagnostic imaging , Stroke/drug therapy , Thrombolytic Therapy/methods , Treatment OutcomeABSTRACT
In recent years, the incidence of ischemic stroke in young people has gradually increased. The etiology and risk factors of young patients with ischemic stroke are complex, including migraine with aura, inherited thrombophilias, hyperhomocysteinemia, cardiovascular risk factors and malignancy. Pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke in young people, which can easily be misdiagnosed and missed due to the lack of specific biomarkers. In this case report, we described a 17-year-old stroke patient who was admitted to hospital due to sudden speech failure accompanied by weakness of the right limb, and was diagnosed with cerebral embolism in the emergency department. After mechanical thrombectomy, the blood vessels were completely recanalized and the symptoms of nerve defects disappeared. Subsequent chest CT examination revealed pulmonary vascular malformations and further pulmonary angiography revealed multiple PAVMs in the lungs. Furthermore, spring coil embolization treatment was performed on 2 PAVMs with an inflow greater than 2 mm. Three months later, enhanced chest CT reexamination showed no recanalization of the malformed vessels at the pulmonary embolism site. Therefore, PAVM should be further not excluded for young stroke patients with unknown causes to avoid misdiagnosis and missed diagnosis, interventional embolization is the best treatment method after diagnosis.
