Abstract WP145: Posterior Circulation ASPECTS As A Predictor Of Clinical Outcomes In Basilar Artery Occlusion Requiring Mechanical Thrombectomy.

Abstract

Introduction: Acute basilar artery (BA) occlusion represents a catastrophic form of acute ischemic stroke. Mechanical thrombectomy (MT) for this disease is frequently performed, despite the lack of level I evidence. In this study, we aim to identify predictors of good outcome in patients with basilar artery occlusions who underwent MT within 24 hours from last seen normal. Method: We conducted a retrospective review study of patients who underwent MT for acute basilar artery occlusions, between October 2012 and October 2018 at our center. The primary endpoint was good functional outcome (modified Rankin Score < 3) at three months. Baseline demographics, clinical, procedural, and radiographic parameters were recorded. We performed a multivariate analysis to determine the predictors of good clinical outcome. Results: Our study included 62 patients with basilar artery occlusions treated within 24 hours from last seen normal: 58% of patients achieved good outcome at 90 days. Age, baseline NIHSS, baseline risk factors and rate of IV tPA administration were comparable between the two groups. Patients with good functional outcome at 90 days were less likely to have a history of stroke (13.9% vs 50%, p = 0.005), more likely to have a higher PC-ASPECTS (10 vs 8, p = 0.0003), and higher successful recanalization rate (91.7% vs 63.6%, p= 0.01). There was a numerically higher number of patients who achieved good outcome within the early time window (less than 6 hours from last seen normal) compared to the 6-24hr time window (50% vs 31.8%, p=0.23). On multivariate logistic regression analysis, the only independent predictor of good functional outcomes was PC-ASPECTS (OR 2.65, 95 % CI 1.47- 4.75, p= 0.00114). Conclusion: In our cohort of patients with BA occlusion who underwent MT, PC- ASPECTs was an independent predictor of good outcome. Prospective studies are warranted to validate our findings.