The Outcome Of Intra-artery Treatment And Collateral Circulation Study After Acute Vertebrobasilar Occlusion:A Meta-analysis

First PartPURPOSE:TO evaluate the safety and efficiency of intra-artery treatment therapy for acute basilar artery occlusion.METHODS:Studies were identified using the MEDLINE, Cochrane, CNKI and Wangfang database from January1981to November2011with keywords "basilar artery occlusion, recanalization, thrombolysis". Random effect or fixed-effect Meta analysis approach was used to estimate the efficiency according to heterogeneity of results of the recanalization rate and clinical outcome, safety with bleeding rate. Relative risks were calculated with95%confidence intervals.RESULTS:12studies with683patients were eligible. Total recanalization rate was71.1%(95%CI63.3%-77.8%), bleeding rate was11.4%(95%CI7.9%-16.0%), and43.0%(95%CI33.3%-53.5%) patients with good neurologic outcome. The patients accepted intra artery treatment within24h had higher recanalization rate and lower bleeding rate (p=0.04and<0.01, respectively), without better neurologic outcome.CONCLUSIONS:The safety and efficiency of intra-artery treatment therapy were low for acute basilar artery occlusion. Early treatment can increase the efficiency and safety significantly. Second PartBACKGROUND AND PURPOSE:This study was undertaken to examine the relationship between collateral circulation and outcome after vertebrobasilar artery occlusion.METHODS:Consecutive patients with bilateral vertebral arteries or basilar artery occlusion underwent digital subtract angiographic (DSA), then were evaluated the collateral grades with Collateral Flow Grading System:Angiographic. We follow the patients with90-days outcome, compared the clinical outcome between good collateral group and poor collateral group.RESULTS:Of the32patients, good clinical outcome was occurred in90.9%(10/11) patients with good collateral grade, whereas it was observed42.8%(9/21) patients in poor collateral grade (F=0.01). The National Institutes of Health Stroke Scale score (NIHSS) and Glasgow Coma Score (GCS) on admission can predict the clinical outcome (P=0.04and0.01respectively). No relationship was found between the clinical outcome and the recanalization, symptom duration, clots site or else risk factors. The collateral status had no significant relationship with age, gender, clots site or the symptom duration.CONCLUSIONS:The good collateral status determines the good clinical outcomes after vertebro-basilar artery occlusion. Pretreatment collateral grade may help guide treatment decision in posterior circulation ischemic stroke.