目的

对照研究静脉溶栓时间窗内桥接治疗与直接取栓动脉粥样硬化性基底动脉闭塞（basilar artery occlusion， BAO）性急性缺血性脑卒中的安全性及有效性。

方法

回顾性分析2018 年1 月至2023 年10 月在江苏省人民医院（南京医科大学第一附属医院）、苏北人民医院、泰州市人民医院以及扬州大学附属医院四个卒中中心收治的，症状发生后4.5 h 内开始治疗的动脉粥样硬化性BAO患者的临床数据。主要评估指标包括90 d 的良好预后率，以及2 组患者的术前临床特征、取栓次数、成功再通率、症状性颅内出血发生率和死亡率等。利用多因素Logistic 回归分析比较两种治疗方案的疗效。

结果

共纳入63 例BAO 患者，其中25 例接受直接机械取栓（直接取栓治疗组）、38 例接受桥接治疗（桥接治疗组）。在调整后的90 d 良好预后率及功能独立率方面，桥接治疗组表现优于直接取栓治疗组（P=0.026 和P=0.011），且桥接治疗组的取栓次数较少（P=0.032）。2 组在成功再通率、症状性颅内出血的发生率、死亡率等方面的差异无统计学意义（P ＞0.05）。

结论

对于在4.5 h 内开始治疗的动脉粥样硬化性BAO 患者，桥接治疗相较于直接机械取栓治疗有更好的预后，且桥接治疗的取栓次数较少。

Objective

To investigate the safety and efficacy of direct thrombectomy versus bridging therapy for patients with acute ischemic stroke caused by arteriosclerotic basilar artery occlusion （BAO）within the intravenous thrombolysis time window.

Methods

This study conducted a retrospective analysis of clinical data from patients with arteriosclerotic basilar artery occlusion （BAO）， who initiated treatment within 4.5 hours of symptom onset， from January 2018 to October 2023， across four stroke centers.The primary evaluation metrics included the rate of favorable prognosis at 90 days， as well as preoperative clinical characteristics， number of thrombectomy attempts， successful reperfusion rates， incidence of symptomatic intracranial hemorrhage， and mortality rates among both patient groups.Efficacy of the two treatment modalities was compared using multivariate logistic regression analysis.

Results

A total of 63 BAO patients were included in the study， with 25 undergoing direct mechanical thrombectomy and 38 receiving bridging therapy.There were no statistically significant differences in preoperative baseline data between the two groups.In terms of the adjusted 90-day good prognosis rate and functional independence rate， the bridging therapy group outperformed the direct thrombectomy group （P=0.026 and P=0.011）， and also required fewer thrombectomy attempts （P=0.032）.No significant differences were observed between the two groups in terms of successful reperfusion rates， incidence of symptomatic intracranial hemorrhage， and mortality rates（P＞0.05）.

Conclusion

For arteriosclerotic BAO patients treated within 4.5 hours， bridging therapy provides a better prognosis compared to direct mechanical thrombectomy， with fewer thrombectomy attempts required.