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Background@#and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. @*Methods@#This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. @*Results@#Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). @*Conclusion@#In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.
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Objective:To investigate the influencing factors for prognoses of patients with acute basilar artery occlusion (BAO) receiving bridging therapy (intravenous thrombolysis [IVT] combined with endovascular treatment [EVT]).Methods:The clinical and imaging data of 404 patients with acute BAO accepted bridging therapy were collected from Endovascular Treatment for acute Basilar Artery Occlusion (ATTENTION) database. The prognoses of these patients were evaluated by modified Rankin Scale (mRS) 90 d after treatment. The differences of clinical and imaging data between patients with good prognosis and poor prognosis were compared, and the independent influencing factors for prognoses were analyzed by multivariate Logistic regression.Results:Among 404 patients with acute BAO, 156 (39%) had good prognosis and 248 (61%) had poor prognosis. Compared with the good prognosis group, the poor prognosis group had significantly higher proportions of patients older than 65 years, patients with NIHSS scores>20 on admission, and patients with thrombectomy frequency>1, significantly lower proportion of patients with successful vascular recanalization, and significantly different distribution of occlusive sites ( P<0.05). Multivariate Logistic regression analysis showed that NIHSS scores on admission>20 ( OR=0.510, 95%CI: 0.331-0.786, P=0.002), and occlusion site at the distal basilar artery ( OR=2.241, 95%CI: 1.357-3.702, P=0.002), thrombectomy frequency>1 ( OR=0.523, 95%CI: 0.339-0.807, P=0.003) and successful vascular recanalization ( OR=2.022, 95%CI: 1.032-3.961, P=0.040) were independent influencing factors for good prognosis of these patients. Conclusion:Acute BAO patients with NIHSS scores>20 on admission, thrombectomy frequency>1, non-distal BAO occlusion, and unsuccessful recanalization have poor prognosis after bridging therapy.
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Objective To evaluate the clinical effect of fire needle in treating vitiligo and the characteristics of vitiligo image by the confocal laser scanning microscope(CLSM).Methods The randomized self-controlled experiment design was adopted.Each patient selected two symmetric or adjacent white patches and randomly received the fire needle treatment or tacrolimus treatment. The duration of treatment was 3 months.The CLSM images of white patches were recorded before treatment and after 3,6 times of fire needle treatment.Results Among 41 cases of stable stage vitiligo,The effective rates of the fire needle group and tacrolimus group were 82.9% and 78.0% respectively,and the difference was not statistically significant(P>0.05).After fire needle treat-ment,dentritic melanin cells appeared,the pigment granules gradually appeared around the basal layer and corpora papillare,and formed the pigment ring.Conclusion Fire needle and tacrolimus have the similar effect in treating vitiligo,moreover CLSM can be used as the non-invasive,objective and reliable detection means of the recovery of vitiligo melanocyte.