Abstract
PurposeEvidence regarding the effect of mechanical thrombectomy (MT) of basilar artery occlusion (BAO) stroke is yet sparse. As successful recanalization has been suggested as major determinant of outcome, the early identification of modifiable factors associated with successful recanalization could be of importance to improve functional outcome. Hyperglycemia has been associated with enhanced thrombin generation and unfavorably altered clot features.ObjectiveWe hypothesized that serum baseline glucose is associated with likelihood of vessel recanalization mediated by collateral quality and clot burden in BAO stroke.MethodsBAO stroke patients who received multimodal CT on admission were analyzed. The association of vessel recanalization defined using modified Thrombolysis in cerebral infarction scale (mTICI) scores 2b-3, and baseline imaging and clinical parameters were tested in logistic regression analyses. Collateral quality and clot burden were evaluated using the Basilar Artery on CT-Angiography (BATMAN) score.ResultsOut of 117 BAO patients, 91 patients (78%) underwent MT. In 70 patients (77%), successful recanalization could be achieved (mTICI 2b/3). In multivariable logistic regression analysis, only a higher BGL (aOR 0.97, 95% CI 0.96–0.99, p = 0.03) and higher BATMAN score (aOR 1.77, 95% CI 1.11–2.82, p = 0.02) were independently associated with vessel recanalization. Application of alteplase, or time from symptom onset-imaging revealed no independent association with recanalization status.ConclusionHigher BGL was significantly associated with reduced likelihood for recanalization success besides BATMAN score as a measure of collateral quality and clot burden. BGL could be tested as a modifiable parameter to increase likelihood for recanalization in BAO stroke, aiming to improve functional outcome.
Highlights
Mechanical thrombectomy (MT) is associated with improved functional outcome when performed in patients with ischemic stroke and large vessel occlusion in the anterior circulation [11, 20, 27]
Better knowledge of the role of baseline serum glucose levels (BGL) in basilar artery occlusion (BAO) stroke may be of high clinical relevance, considering that in contrast to anterior circulation stroke, diagnosis is often delayed and reperfusion rates are very low in the absence of MT (i.e. 4% [2]) [7, 8]
The aim of this study was to investigate factors associated with successful recanalization in acute BAO patients, and in particular, analyze how baseline BGL and the BATMAN score, as a measure of collateral quality and clot burden, are associated with reperfusion
Summary
Mechanical thrombectomy (MT) is associated with improved functional outcome when performed in patients with ischemic stroke and large vessel occlusion in the anterior circulation [11, 20, 27]. Successful vessel recanalization has been described as the most important predictor of good functional outcome in BAO stroke [7]. The early identification of factors, especially modifiable factors, associated with successful recanalization could be of clinical importance to improve functional outcome in BAO patients. The impact of baseline serum glucose levels (BGL) on recanalization success, especially in BAO stroke patients, remains uncertain. A previous study observed that stroke patients medicated with sulfonylureas had better outcomes [16]. It has not been investigated whether BGL is associated with likelihood of recanalization. Better knowledge of the role of BGL in BAO stroke may be of high clinical relevance, considering that in contrast to anterior circulation stroke, diagnosis is often delayed and reperfusion rates are very low in the absence of MT (i.e. 4% [2]) [7, 8]
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