Acute Basilar Artery Occlusion Patients Research Articles

Abstract WMP90: Outcomes of Endovascular Treatment versus Best Medical Treatment for Acute Basilar-Artery Occlusion: Impacts of Etiology in the ATTENTION Randomized Trial

Objective: This study aimed to evaluate the efficacy and safety of endovascular treatment versus best medical treatment strategies in acute basilar artery occlusion with different stroke etiologies. Methods: The study was a post-hoc analysis of the Trial of Endovascular Treatment of Acute Basilar-artery Occlusion (ATTENTION), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute basilar artery occlusion were classified into three groups according to stroke etiology: large-artery atherosclerosis (LAA), cardioembolism (CE), and undetermined/other determined cause (UC/ODC). The primary outcome was favorable outcome (modified Rankin scale 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality. Results: A total of 340 patients were included. Compared with best medical treatment, endovascular treatment was associated with higher rates of favorable outcome at 90 days in the LAA group (49.1% vs 23.8%; adjusted odds ratio [aOR] 2.79; 95% confidence interval [CI] 1.16-6.71), CE group (52.2% vs 30.8%; aOR 3.68; 95%CI 1.04-12.97), and UC/ODC group (37.5% vs 17.4%; aOR 5.73, 95%CI 1.99-16.48). The rate of symptomatic intracranial hemorrhage in patients receiving endovascular treatment with LAA, CE and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the best medical treatment patients. Endovascular treatment led to lower 90-day mortality than best medical treatment in LAA patients (33.3% vs 57.1%; aOR 0.41; 95% CI 0.19-0.91). Among patients receiving endovascular treatment, a better functional outcomes of CE etiology was found than the UC/ODC etiology (52.2% vs 37.5%; aOR 2.68; 95% CI 1.07-6.70); there was no differences in symptomatic intracranial hemorrhage and 90-day mortality among the three etiology subtypes. Conclusion: Endovascular treatment was associated with better outcomes than the best medical treatment in acute basilar artery occlusion patients regardless of stroke etiologies, but the benefits-risk ratios were different among etiologies. The stroke etiology might be an important factor in predicting the prognosis of thrombectomy in acute basilar artery occlusion.

Association of Renal Impairment with Clinical Outcomes Following Endovascular Therapy in Acute Basilar Artery Occlusion.

Renal impairment (RI) is associated with unfavourable outcome after acute ischaemic stroke with anterior circulation large vessel occlusion. We assessed the association of RI with clinical outcomes in patients with acute basilar artery occlusion (ABAO), and the impact of RI on the effects of endovascular therapy (EVT) versus standard medical treatment (SMT). We used data from the BASILAR registry, an observational, prospective, nationwide study of patients with ABAO in routine clinical practice in China. Baseline estimated glomerular filtration rate (eGFR) was recorded at admission. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included favourable outcome (mRS score 0-3), mortality, and symptomatic intracranial haemorrhage (sICH). Multivariate logistic regression was used to assess the association of RI with mortality and functional improvement at 90 days. Among 829 patients enrolled, 747 patients were analysed. The median baseline eGFR was 89 mL/min/1.73m2 (IQR, 71-100), and 350 (46.8%), 297 (39.8%), and 100 (13.4%) patients had baseline eGFR values of ≥90, 60-89, and <60 mL/min/1.73m2, respectively. RI was associated with increased mortality (adjusted odds ratio [aOR], 1.97; 95% CI, 1.15-3.67) at 90 days and decreased survival probability (aOR 1.74; 95% CI, 1.30-2.33) within 1 year. EVT was associated with better functional improvement (common aOR, 2.50; 95% CI, 1.43-4.35), favourable outcome (aOR 5.42; 95% CI, 1.92-15.29) and lower mortality (aOR 0.47; 95% CI, 0.25-0.88) in ABAO patients with eGFR ≥90 mL/min/1.73m2. However, RI was not modified the relationship of EVT with functional improvement (common aOR, 3.03; 95% CI, 0.81-11.11), favourable outcome (aOR 2.10; 95% CI, 0.45-9.79), and mortality (aOR 0.56; 95% CI, 0.15-2.06) by eGFR categories. RI is associated with reduced efficacy of EVT and worse functional outcome and higher mortality at 3 months and lower survival probability at 1 year in patients with ABAO.

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

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 &gt;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 &amp;ndash; 0.658, P = 0.001), procedure time (OR: 1.028, 95% CI: 1.007 &amp;ndash; 1.050, P = 0.01), and natural logarithm-transformed of the SIRI (Ln[SIRI]) (OR: 2.857, 95% CI: 1.518 &amp;ndash; 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 &amp;ndash; 0.878; P &lt; 0.001). The effects of ACGS-BAO and Ln(SIRI) on FR were similar in all subgroups (P &gt; 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.

Asymmetric deep cerebral venous filling predicts poor outcome of acute basilar artery occlusion after endovascular treatment.

To explore the relationship between asymmetric deep cerebral venous (ADCV) filling and poor outcomes after endovascular treatment (EVT) in patients with acute basilar artery occlusion (ABAO). ABAO patients were selected from a prospectively collected data at our center. The DCV filling was evaluated using computed tomography perfusion (CTP)-derived reconstructed 4D-DSA or mean venous map. ADCV filling was defined as the internal cerebral vein (ICV), thalamostriate vein (TSV), or basal vein of Rosenthal (BVR) presence of ipsilateral filling defects or delayed opacification compared to the contralateral side. Poor prognosis was defined as a modified Rankin scale score >3 at the 90-day follow-up. A total of 90 patients were enrolled in the study, with a median Glasgow Coma Scale of 6, 46 (51.1%) showed ADCV filling, 59 (65.6%) had a poor prognosis, and 27 (30.7%) had malignant cerebellar edema (MCE). Multivariate adjusted analysis revealed significant associations between asymmetric TSV and poor prognosis (odds ratio, 9.091, p = 0.006); asymmetric BVR (OR, 9.232, p = 0.001) and asymmetric ICV (OR, 4.028, p = 0.041) were significantly associated with MCE. Preoperative ADCV filling is an independent influencing factor for the poor outcome after EVT in ABAO patients.

Nomogram model of functional outcome for endovascular treatment in patients with acute basilar artery occlusion.

The efficacy and safety of endovascular treatment (EVT) in acute basilar artery occlusion (ABAO) has been confirmed by four randomized clinical trials. Nevertheless, the predictors of a 90-day favorable outcome after EVT have not been elucidated. We attempted to establish a nomogram for the prediction of a 90-day favorable outcome in ABAO patients with EVT. Clinical data of ABAO patients with EVT were obtained from two nationwide clinical trial registries in China. Factors associated with a 90-day favorable outcome were screened by multivariable step-wise regression on the basis of univariable analysis. A nomogram was established to predict 90-day favorable outcome after EVT. The proportion of ABAO patients with a favorable outcome was 41.53% (157/378). Seven variables, including baseline National Institutes of Health Stroke Scale (NIHSS) <20 [odds ratio (OR): 8.330; P-value < 0.0001], posterior circulation Alberta Stroke Program Early CT (pc-ASPECT) score ≥7 (OR: 1.948; P-value = 0.0296), Pons-Midbrain Index (PMI) score < 2 (OR: 2.108; P-value = 0.0128), Posterior Circulation Collateral Score (PC-CS) ≥5 (OR: 3.288; P-value < 0.0001), local anesthesia (OR: 0.389; P-value = 0.0017), time from onset to recanalization (OTR) <330 min (OR: 2.594; P-value = 0.0013), and no occurrence of early neurological deterioration (END; OR: 0.039; P-value < 0.0001) were included into the nomogram, with C-index values of 0.8730 and 0.8857 in the training and the internal validation set, respectively. The proposed nomogram provided a reliable prognostic scale, which can be employed in clinical settings for the selection and clinical management of ABAO patients. https://www.clinicaltrials.gov, identifier: NCT03370939.

Effect of massive cerebellar infarction on the outcomes of patients with acute basilar artery occlusion during hospitalization after endovascular treatment: A retrospective study.

Acute basilar artery occlusion (ABAO) after endovascular treatment (EVT) is often associated with a poor prognosis, particularly in patients with cerebellar infarction who may develop malignant cerebellar edema. The present study aimed to investigate how massive cerebellar infarction (MCI) affects hospitalization outcomes in ABVO patients who undergo EVT. We conducted a retrospective study of ABVO patients who underwent EVT at our hospital between September 2017 and September 2022. MCI was diagnosed using imaging techniques, and various prognostic scores were assessed during hospitalization to examine the relationship between MCI and these outcomes. We identified 42 ABAO patients, of whom 22 (52.4%) had MCI. Patients with MCI had a higher modified Rankin Scale (mRS) score at discharge compared to those without MCI (4.36 ± 1.14 vs 3.05 ± 1.85, P = .042, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (0.083, 2.103)), and a lower Glasgow Coma Scale score (6.59 ± 4.0 vs 10.10 ± 5.07, P = .036, OR (95% CI) = -3.444 (-6.518, -0.369)). MCI was identified as an independent risk factor for an extremely poor prognosis (mRS ≥ 5) at discharge (P = .036, OR (95% CI) = 15.531 (1.603, 313.026)) and for no improvement in mRS score compared to onset (P = .013, OR (95% CI) = 0.025 (0.001, 0.274)). Additionally, an extremely poor prognosis was independently associated with stent implantation, EVT duration, and body mass index, while mRS score improvement was correlated with EVT duration and pulmonary infection. MCI in ABAO patients is a significant independent risk factor for a poor prognosis at discharge and no improvement in function score compared to onset. Early diagnosis and intervention are necessary to improve outcomes, particularly in high-risk populations.

Intra-Arterial Thrombolysis Associated with Symptomatic Intracranial Hemorrhage in Acute Basilar Artery Thrombectomy, PC-SEARCH Registry Analysis (P8-5.008)

Intra-Arterial Thrombolysis Associated with Symptomatic Intracranial Hemorrhage in Acute Basilar Artery Thrombectomy, PC-SEARCH Registry Analysis (P8-5.008)

Real-World Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion: Results of the BArONIS Study.

To evaluate clinical outcomes of endovascular thrombectomy (EVT) for acute basilar artery occlusion (BAO) using population-level data from the United States. Weighted discharge data from the National Inpatient Sample were queried to identify adult patients with acute BAO during the period of 2015 to 2019 treated with EVT or medical management only. Complex samples statistical methods and propensity-score adjustment using inverse probability of treatment weighting (IPTW) were performed to assess clinical endpoints. Among 3,950 BAO patients identified, 1,425 (36.1%) were treated with EVT [mean age 66.7 years, median National Institute of Health Stroke Scale (NIHSS) score 22]. On unadjusted analysis, 155 (10.9%) EVT patients achieved favorable functional outcomes (discharge disposition to home without services), while 515 (36.1%) experienced in-hospital mortality, and 20 (1.4%) developed symptomatic intracranial hemorrhage (sICH). Following propensity-score adjustment by IPTW accounting for age, stroke severity, and comorbidity burden, EVT was independently associated with favorable functional outcome [adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.07, 1.46; p=0.004], but not with in-hospital mortality or sICH. In an IPTW-adjusted sub-group analysis of patients with NIHSS scores >20, EVT was associated with both favorable functional outcome (discharge disposition to home or to acute rehabilitation) (aOR 1.55, 95% CI 1.24, 1.94; p < 0.001) and decreased mortality (aOR 0.78, 95% CI 0.69, 0.89; p < 0.001), but not with sICH. This retrospective population-based analysis using a large national registry provides real-world evidence of a potential benefit of EVT in acute BAO patients. ANN NEUROL 2023;94:55-60.

Development and validation of machine learning-based model for mortality prediction in patients with acute basilar artery occlusion receiving endovascular treatment: multicentric cohort analysis

BackgroundPredicting mortality in stroke patients using information available before endovascular treatment (EVT) is an essential component for supporting clinical decision-making. Although the mortality rate of acute basilar artery occlusion (ABAO)...

Patterns of Care in Patients with Basilar Artery Occlusion (BAO): A Population-Based Study

Basilar artery occlusion (BAO) is associated with high morbidity and mortality. Endovascular therapy (EVT) has been shown to be beneficial in acute BAO patients. This retrospective observational study used the National Inpatient Sample (NIS) database to identify BAO patients using the International Classification of Diseases (ICD). Multivariable models were used to evaluate the association of risk factors, comorbidities, length of stay (LOS) in hospital, total cost, disposition, and transfer status. A total of 1120 (447 females, 39.95%) patients were identified, with a higher proportion of White individuals (66.8% vs. 57.6%), atrial fibrillation (31.5% vs. 17.2%; p < 0.0001), and peripheral vascular disease (21.2% vs. 13.7%; p = 0.009). A lower proportion of individuals with diabetes mellitus (32.1% vs. 39.5%; p = 0.05) was found in the EVT group. Majority of the patients (924/1120, 82.5%) were treated at the urban teaching facility, which also performed most of the EVT procedures (164, 89.13%), followed by non-academic urban (166, 14.8%) and rural (30, 2.7%) hospitals. Most patients (19/30, 63%) admitted to rural hospitals were transferred to other facilities. Urban academic hospitals also had the highest median LOS (8.9 days), cost of hospitalization (USD 117,261), and disposition to home (32.6%). This study observed distinct patterns and geographical disparities in the acute treatment of BAO patients. There is a need for national- and state-level strategies to improve access to stroke care.

Abstract Number: LBA13 Relationship Between Vertebral Artery Dominance And Incidence Of Embolic Basilar Artery Occlusion

Introduction Vertebral artery asymmetry due to hypoplasia or early termination is common in the general population with 50% left dominance, 25% right dominance, and 25% codominance. Our aim was to identify if an association exists between vertebral artery dominance and incidence of embolic basilar artery occlusion. Methods Retrospective chart review of patients presenting to our comprehensive stroke center with acute ischemic stroke (AIS) secondary to embolic basilar artery occlusion were reviewed. Artery‐to‐artery occlusions related to athersclerotic steno‐occlusive disease or proximal dissection with distal thromboembolism were excluded. Successful recanalization was identified as a modified treatment in cerebral infarction (mTICI) score of 2b and 3. Fisher exact test statistic was used to assess for significant differences in recanalization. Social science statistics software was used for data analysis. Results From May 2017 to November 2019, 29 patients with acute basilar occlusions undergoing thrombectomy were identified. Acute basilar artery occlusion patients had a dominant right vertebral artery (31%, n = 9), codominant vertebral arteries (31%, n = 9) and dominant left vertebral artery (38%, n = 11). Successful recanalization of TICI 2b or higher was achieved in 89.6% (n = 26). Difference between successful recanalization and right or left vertebral artery dominance was not statistically significant (Fisher exact test statistic value 0.48). Conclusions Our study suggests a higher proportion of our patients presenting with basilar artery occlusion had right vertebral artery dominance or codominant pattern. Larger, studies are needed to validate our results.

A DWI-based radiomics-clinical machine learning model to preoperatively predict the futile recanalization after endovascular treatment of acute basilar artery occlusion patients

ObjectiveTo develop an effective machine learning model to preoperatively predict the occurrence of futile recanalization (FR) of acute basilar artery occlusion (ABAO) patients with endovascular treatment (EVT). Materials and MethodsData from 132 ABAO patients (109 male [82.6 %]; mean age ± standard deviation, 59.1 ± 12.5 years) were randomly divided into the training (n = 106) and test cohort (n = 26) with a ratio of 8:2. FR is defined as a poor outcome [modified Rankin Scale (mRS) 4–6] despite a successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b]. A total of 1130 radiomics features were extracted from diffusion-weighted imaging (DWI) images. The least absolute shrinkage and selection operator (LASSO) regression method was applicated to select features. Support vector machine (SVM) was applicated to construct radiomics and clinical models. Finally, a radiomics-clinical model that combined clinical with radiomics features was developed. The models were evaluated by receiver operating characteristic (ROC) curve and decision curve. ResultsThe area under the receiver operating characteristic (ROC) curve (AUC) of the radiomics-clinical model was 0.897 (95 % confidence interval, 0.837–0.958) in the training cohort and 0.935 (0.833–1.000) in the test cohort. The AUC of the radiomics model was 0.887 (0.824–0.951) in the training cohort and 0.840 (0.680–1.000) in the test cohort. The AUC of the clinical model was 0.746 (0.652–0.840) in the training cohort and 0.766 (0.569–0.964) in the test cohort. The AUC of the radiomics-clinical model was significantly larger than the clinical model (p = 0.016). A radiomics-clinical nomogram was developed. The decision curve analysis indicated its clinical usefulness. ConclusionThe DWI-based radiomics-clinical machine learning model achieved satisfactory performance in predicting the FR of ABAO patients preoperatively.

Predictors of delayed reocclusion after successful recanalization in acute basilar artery occlusion patients

BackgroundDelayed reocclusion (DR) after successful recanalization in acute basilar artery occlusion (BAO) patients, which is associated with clinical deterioration and poor outcome, has not been well studied. The current study is aimed to predict DR after successful endovascular therapy in acute BAO patients. Method187 consecutive patients presenting with acute BAO and undergoing endovascular treatment (EVT) were selected in Beijing Tiantan Hospital from January 2012 to July 2018. Computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) within 7 days of the thrombectomy was used to identify reocclusion of the target vessel. Multivariable logistic regression analysis was used to evaluate associated factors and clinical impact. ResultsDR was observed in 17 of 169 successfully reperfused patients (10.1%). Patients with DR had higher frequency of intracranial atherosclerotic stenosis (ICAS) (94.1% vs. 61.8%; P = 0.01), higher frequency of intracranial angioplasty during EVT (88.2% vs. 57.2%; P = 0.02), lower frequency of stent-retriever use during EVT (52.9% vs. 78.9%; P = 0.03) and a lower proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 3 reperfusion (41.2% vs. 78.3%; P < 0.01). Suggestive predictors were mTICI3 reperfusion (aOR, 0.205; 95% CI, 0.061–0.686) and stent-retriever using (aOR, 0.29; 95% CI, 0.086–0.980). DR was an independent predictor of unfavorable outcome at 90 days (aOR for mTICI ≤3, 5.205; 95% CI, 1.129–24.005). ConclusionsDR within 7 days after successful mechanical thrombectomy in acute BAO patients is rare but associated with poor outcome. Patients without mTICI3 reperfusion and stent-retriever using are at high risk for DR.

Abstract WP12: The Golden 75 Min And Black 120 Min For Acute Basilar Artery Occlusion Intervention: Effect Of Procedure Time On Outcome

Background and Objectives: Previous studies have shown the impact of procedure time (PT) on large vessel occlusion (LVO), however, the relationship for patients with acute basilar artery occlusion (ABAO) was not clear. We aimed to characterize the impact of PT and other procedure-related variables on clinical outcomes among patients with ABAO that underwent mechanical thrombectomy (MT). Methods: Patients with ABAO that underwent MT with a documented PT in the BASILAR study from January 2014 to May 2019 among 47 comprehensive centers in China were included. Multivariable analysis was performed to reveal the association between PT and 90-day modified Rankin Scale score, mortality, complications, and all-cause death at one year. Results: Of the 829 patients from the BASILAR registry, 633 eligible patients were included. A decreased likelihood of favorable outcomes (defined as a modified Rankin Scale score of 0-3 at 90 days) was demonstrated when PT exceeded 60 min (P &lt; 0.001). Additionally, a PT ≤ 75 min independently predicted favorable outcomes (adjusted OR 2.28[95% CI 1.41- 3.68], respectively). The risk of complications and mortality increased by 0.5% and 1.5% with every 10 min increase in PT, respectively (R 2 = 0.64 and R 2 = 0.68, P &lt;0.01). The cumulative rates of favorable outcomes and successful recanalization plateaued after 120 min (2 attempts). Restricted cubic spline regression analysis for the probability of favorable outcomes had an L-shape association (P non-linearity = 0.048) with PT with significant benefit loss before 120 min and then appeared relatively flat. Discussion: For ABAO patients, procedures that exceeded 75 min increased the risk of mortality and decreased the likelihood of a favorable outcome. For procedures exceeding 120 min the benefits and costs of continuing the procedure should be carefully considered. Classification of Evidence: This study provides Class II evidence for ABAO patients undergoing EVT.

Factors influencing the prognosis of acute basilar artery occlusion patients treated endovascularly: the impact of treatment time window and preoperative symptoms.

The aim of this study was to examine the factors influencing the prognosis of patients diagnosed with acute basilar artery occlusion (BAO) who receive endovascular treatment. Our particular emphasis was on the predictive implications of the time window for treatment (from symptom onset to femoral artery puncture) and preoperative symptoms for prognosis. A retrospective analysis of data collected from 51 BAO patients who received endovascular treatment at the Neurosurgery Department of Jinhua Central Hospital from April 2018 to October 2021 was undertaken. The data included immediate post-interventional recanalization rates and the 90-day clinical prognoses of the patients. We used the Modified Rankin Scale (mRs) to categorize patients into two prognosis groups: a favorable prognosis group (mRs score ≤2) and an unfavorable prognosis group (mRs score >2). Preoperative symptoms were gauged using the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores. A logistic regression analysis was conducted to identify risk factors affecting the prognosis of BAO patients following endovascular treatment. The procedure resulted in complete recanalization in all patients (100%). However, four patients (7.8%) passed away during the postoperative hospitalization period. The remaining 47 patients were followed up for 3 months. It was found that 15 patients (31.91%) had a favorable prognosis, while 32 (68.09%) had an unfavorable prognosis. It was generally observed that patients with an unfavorable prognosis had notably higher preoperative GCS and NIHSS scores (p < 0.05). Logistic regression analysis revealed that preoperative symptom severity, as indicated by NIHSS score, and treatment time window were significant prognostic risk factors for patients undergoing endovascular treatment for BAO (p < 0.05). Endovascular intervention for BAO appears to be safe and effective, with greater likelihood of a favorable prognosis in patients treated within ≤6 h. The chances of favorable prognosis could potentially be linked to the severity of the patient's preoperative symptoms.

Prognostic value of pretreatment diffusion-weighted imaging score for acute basilar artery occlusion with successful endovascular recanalization.

The aim of this study is to test the prognostic value of a diffusion-weighted imaging (DWI) score in acute basilar artery occlusion (ABAO) with successful recanalization. The DWI-based pons-midbrain and thalamus (PMT) score was developed to assess posterior circulation infarcts. We test its prognostic value and compare it with other two established scales, the DWI-based posterior circulation acute stroke prognosis Early CT score (PC-ASPECTS) and brain stem score (BSS). A retrospective cohort of consecutive ABAO patients with pretreatment magnetic resonance imaging and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction 2b-3) were analyzed. A favorable outcome was defined as a 90-day modified Rankin Scale (mRS) score of 2 or less. The prognostic performance of three scales was estimated by receiver operating characteristic (ROC) curve analyses. One hundred and sixteen eligible patients (mean age, 59.1 ± 11.7 [standard deviation]; 96 [82.8%] man) were included and evaluated. Between favorable (mRS ≤ 2) and unfavorable groups, the baseline PMT score (median [interquartile range], 3 [1-4] versus 6 [5-8]; P < 0.001) differs significantly. ROC curve analyses showed the PMT score had the best prognostic value for favorable outcome (area under the curve, PMT versus BSS versus PC-ASPECTS = 0.80 versus 0.72 versus 0.68, P = 0.010). Multivariate logistic regression analyses showed baseline National Institute of Health stroke scale (OR, 0.90 [95%CI, 0.86-0.95], P = 0.004) and PMT score < 5 (OR, 17.83 [95%CI, 3.91-81.19], P < 0.001) were independent prognostic factors of favorable outcome. The PMT score seems to predict clinical outcome of ABAO patients with successful recanalization.

Outcome prediction value of critical area perfusion score for acute basilar artery occlusion.

To investigate the performance of the Critical Area Perfusion Score (CAPS), based on computed tomography perfusion (CTP) time to maximum (Tmax) > 10s maps, to predict the outcome in acute basilar artery occlusion (BAO) in patients undergoing endovascular treatment (EVT). We perform a retrospective analysis of a prospectively collected database of acute BAO treated with EVT in a comprehensive stroke center. The favorable outcome was defined as the 90-day modified Rankin Scale (mRS) ≤ 3. We performed the logistic regression analysis to find the independent predictors of the favorable outcome. Then, we used receiver operating characteristic analyses to assess the predictive value of the imaging parameters, including CAPS, Posterior Circulation Alberta Stroke Program Early CT Score (PC-ASPECTS), pons midbrain index (PMI), posterior circulation computed tomography angiography (PC-CTA) score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, and CTP parameters. Finally, the Delong test was used to compare the area under the curve (AUC) of CAPS against the other imaging parameters. Of the 65 enrolled patients, the incidence of the favorable outcome was 44.6% (29/65). Low CAPS (per 1- point increased odds ratio [OR], 0.43; 95% confidence interval [CI], 0.22-0.86; P = 0.017) and admission National Institutes of Health Stroke Scale (NIHSS) (per 1- point increased OR, 0.80; 95% CI, 0.70-0.91; P = 0.001) were independently associated with favorable outcome. The AUC of CAPS was 0.83 (95% CI, 0.74-0.93; P < 0.001) with ≤ 3 cut-off value, 89.66% sensitivity, 77.22% specificity, and 80.00% accuracy, which was greater than the other imaging parameters (All P for Delong test < 0.05). CAPS was the most accurate imaging-based outcome predictor in acute BAO patients. Future large prospective multicenter studies are needed to verify these results.

Abstract WP151: Outcome Of Endovascular Treatment For Acute Basilar Artery Occlusion With Moderate Deficit

Background and Purpose: This study aimed to investigate the efficacy and safety of endovascular treatment (EVT) in patients with acute basilar artery occlusion and moderate deficit (National Institutes of Health Stroke Scale [NIHSS] score 10 to 20) versus standard medication treatment (SMT) alone. Methods: Patients from a nationwide prospective registry termed BASILAR (the Endovascular Treatment for Acute Basilar Artery Occlusion Study) were divided into three kinds of population according to NIHSS, including patients with mild deficit (NIHSS score &lt;10), moderate deficit (NIHSS score 10-20) and severe deficit (NIHSS score&gt;20). Then patients with moderate deficit were identified and divided into two groups for analysis: EVT group or SMT-alone group. The primary efficacy outcome was a favorable functional outcome (modified Rankin Scale score 0-3) at 90 days and safety outcomes were symptomatic intracerebral hemorrhage and mortality at 90 days. Results: A total of 194 patients had moderate deficit of which 47 patients treated with SMT-alone and 147 patients treated with EVT. Compared with patients in the SMT-alone group, patients undergoing EVT were associated with significant higher proportion of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 3.36 [95%CI, 1.14-9.92]; P = .028) but no statistically significant difference was found in 90-day mortality (adjusted odds ratio, 0.53 [95% CI, 0.25-1.14]; P = .10) despite a higher rate of symptomatic intracerebral hemorrhage (4 of 146 patients [2.7%] vs 0 of 47 patients [0%]). Conclusions: This study suggests that EVT in acute basilar artery occlusion patients with moderate deficit may be associated with better functional outcomes. More randomized clinical trials were in need to explore the management of these patients.

Predictive value of DWI posterior-circulation lesion volume for 90-day clinical outcome after endovascular treatment of acute basilar artery occlusion: a retrospective single-center study.

The relationship between posterior-circulation lesion volume (PCLV) and clinical outcomes is poorly investigated. We aimed to analyze, in patients with acute basilar artery occlusion (ABAO), if pre-endovascular treatment (EVT) PCLV was a predictor of outcomes. We analyzed consecutive MRI selected, endovascularly treated ABAO patients. Baseline PCLV was measured in milliliters on apparent diffusion-coefficient map reconstruction. Univariable and multivariable logistic models were used to test if PCLV was a predictor of 90-day outcomes. After the received operating characteristic (ROC) analysis, the optimal cut-off was determined to evaluate the prognostic value of PCLV. A total of 110 ABAO patients were included. The median PCLV was 4.4ml (interquartile range, 1.3-21.2ml). Successful reperfusion was achieved in 81.8% of cases after EVT. At 90days, 31.8% of patients had a modified Rankin scale ≤ 2, and the mortality rate was 40.9%. PCLV was an independent predictor of functional independence and mortality (odds ratio [OR]:0.57, 95% confidence interval [CI], 0.34-0.93 and 1.84, 95% CI, 1.23-2.76, respectively). The ROC analysis showed that a baseline PCLV ≤ 8.7ml was the optimal cut-off to predict the 90-day functional independence (area under the curve [AUC] = 0.68, 95% CI, 0.57-0.79, sensitivity 88.6%, and specificity 49.3%). In addition, a PCLV ≥ 9.1ml was the optimal cut-off for the prediction of 90-day mortality (AUC = 0.71, 95% CI, 0.61-0.82, sensitivity 80%, and specificity 60%). Pre-treatment PCLV was an independent predictor of 90-day outcomes in ABAO. A PCLV ≤ 8.7 and ≥ 9.1ml may identify patients with a higher possibility to achieve independence and a higher risk of death at 90days, respectively.

Abstract P619: A Non-Linear Relationship Between Time From Onset to Endovascular Therapy and Outcomes in Patients With Acute Basilar Artery Occlusion in Clinical Practice

Objective: Faster time from onset to puncture (OPT) using endovascular therapy (EVT) in acute large-vessel occlusion of anterior circulation has been associated with better clinical outcomes. However, the relationship in acute basilar artery occlusion (BAO) is still not well delineated. Methods: We analyzed acute BAO patients receiving EVT from a nationwide registry of BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion study). The primary outcome was favorable functional outcome (defined as modified Rankin Scale score 0-3) at 90 days. Secondary outcomes included function independence (defined as modified Rankin Scale score 0-2), mortality and symptomatic intracerebral hemorrhage. The associations between OPT and outcomes were evaluated using multivariable logistic regression (OPT as a categorical variable) and restricted cubic spline regression (OPT as a continuous variable). Results: Among 639 eligible patients, the median age was 65 years, and median OPT was 328 mins (interquartile range, 220-490). Treatment within 4 hours were associated with higher rates of functional independence (adjusted OR, 0.60 [95% CI, 0.37-0.97] and 0.46 [95% CI, 0.22-0.97], respectively) and favorable outcome (adjusted OR, 0.63 [95% CI, 0.40-0.99] and 0.46 [95% CI, 0.24-0.96], respectively) compared with treatment within 4-8 hours and 8-12 hours. In the restricted cubic spline models, nonlinear relationships were consistently observed between OPT with favorable outcome, functional independence and mortality, with significant benefit loss throughout the first 10 hours but then a relative flat afterwards. However, the odds of symptomatic intracerebral hemorrhage did not significantly change with longer delay to EVT. Conclusion: Among patients with acute BAO in routine practice, earlier treatment with EVT was associated with better outcomes throughout the first 10 hours after onset, but benefit sustained unchanged afterwards. Future trials or pooled analysis of larger size BAO patients are needed to confirm these results.