Predicting futile recanalization risk in acute basilar artery occlusion: Combination of collateral status and pre-procedural systemic inflammation response index

Abstract

Acute basilar artery occlusion (ABAO) is a rare form of acute ischemic stroke (AIS). Endovascular treatment (EVT) has emerged as a primary therapeutic approach for achieving early reperfusion of the ischemic area. However, a favorable prognosis remains elusive for a considerable number of patient post-recanalization. The assessment of disparities in hematological and radiological indicators is of notable significance for predicting the prognosis of AIS patients. Our study aimed to predict futile recanalization (FR) by analyzing inflammation levels and collateral status in ABAO patients treated with EVT. Clinical data were collected from January 2019 to March 2023. The angiographic collateral grading system for basilar artery occlusion (ACGS-BAO) and the systemic inflammation response index (SIRI) was employed to assess the collateral status and inflammation levels, respectively. FR was defined as patients experiencing an unfavorable functional outcome (modified Rankin Scale >2) at 3-month post-EVT, despite successful recanalization (modified Thrombolysis in Cerebral Infarction 2b or 3). Logistic regression models were utilized to analyze the association of ACGS-BAO and SIRI with FR. A total of 72 (65.5%) patients developed FR. Multivariate logistic analysis revealed that ACGS-BAO (odds ratio [OR]: 0.343, 95% confidence interval [CI]: 0.179 – 0.658, P = 0.001), procedure time (OR: 1.028, 95% CI: 1.007 – 1.050, P = 0.01), and natural logarithm-transformed of the SIRI (Ln[SIRI]) (OR: 2.857, 95% CI: 1.518 – 5.380, P = 0.001) were independently associated with FR. In receiver operating characteristic analysis, the area under the curve for ACGS-BAO combined SIRI was 0.789 (95% CI: 0.699 – 0.878; P < 0.001). The effects of ACGS-BAO and Ln(SIRI) on FR were similar in all subgroups (P > 0.10 for all interactions). In conclusion, poor collateral status and high inflammatory levels are independent predictors of FR after EVT in patients with ABAO.