1
|
Yue C, Deng W, Liu J, Luo X, Miao J, Liu J, Zheng B, Du J, Zhang Y, Yang S, Zi W, Li F. Endovascular treatment in patients with coma that developed secondary to acute basilar artery occlusion. J Neurosurg 2022; 137:1491-1500. [PMID: 35303706 DOI: 10.3171/2022.1.jns212967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of endovascular treatment (EVT) in patients with secondary coma following acute basilar artery occlusion (comatose patients) and to identify the impact of the Glasgow Coma Scale (GCS) score on medical decisions. METHODS Patients from the Endovascular Treatment for Acute Basilar Artery Occlusion study were divided into comatose and noncomatose cohorts. The primary outcome was favorable functional independence (modified Rankin Scale [mRS] scores 0-3). The safety outcome was 90-day mortality. Subgroup analysis was performed to identify populations best suited for EVT. Multivariate logistic regression was used to identify independent predictive factors of clinical outcomes. RESULTS Comatose patients who underwent EVT had more favorable functional outcomes and lower mortality compared with those who underwent standard medical treatment (functional outcomes: 15.98% vs 4.17%; mortality: 62.72% vs 82.29%). Moreover, EVT was associated with better outcomes in the cohort with GCS scores of 6-8 (mRS scores 0-3, 25.33% and mortality, 41.33%) than in the cohort with GCS scores of 3-5. Multivariate analysis indicated that EVT was an independent factor for favorable functional outcomes (adjusted OR 8.921, 95% CI 2.330-34.158) and mortality (adjusted OR 0.189, 95% CI 0.092-0.411) in comatose patients. The initial GCS score was an independent factor for favorable functional outcomes (adjusted OR 1.402, 95% CI 1.115-1.763) and mortality (adjusted OR 0.613, 95% CI 0.499-0.752) in comatose patients with EVT. CONCLUSIONS EVT significantly improved the prognosis of comatose patients, and patients with GCS scores of 6-8 were found to benefit more from EVT than those with GCS scores of 3-5. The initial GCS score was an independent predictive factor for prognosis in comatose patients.
Collapse
Affiliation(s)
- Chengsong Yue
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Deng
- 2Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Juan Liu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaojun Luo
- 3Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Jian Miao
- 4Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Jincheng Liu
- 5Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang, China
| | - Bo Zheng
- 6Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Jie Du
- 7Department of Neurology, Kaizhou District People's Hospital, Chongqing, China
| | - Yuxian Zhang
- 8Department of Neurology, Danzhai County People's Hospital, Danzhai, China; and
| | - Shunyu Yang
- 9Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wenjie Zi
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| |
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW This article discusses the diagnostic and therapeutic approach to patients who are comatose and reviews the current knowledge on prognosis from various causes of coma. This article also provides an overview of the principles for determination of brain death as well as advice on how to avoid common pitfalls. RECENT FINDINGS Technologic advances have refined our understanding of the physiology of consciousness and the spectrum of disorders of consciousness; they also promise to improve our prognostic accuracy. Yet the clinical principles for the evaluation and treatment of coma remain unaltered. The clinical standards for determination of death by neurologic criteria (ie, brain death) are also well established, although variabilities in local protocols and legal requirements remain a problem to be resolved. SUMMARY Effective evaluation of coma demands a systematic approach relying on clinical information to ensure rational use of laboratory and imaging tests. When the cause of coma is deemed irreversible in the setting of a catastrophic brain injury and no clinical evidence exists for brain and brainstem function, patients should be evaluated for the possibility of brain death by following the clinical criteria specified in the American Academy of Neurology guidelines.
Collapse
|