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A Pre-Intervention 4-Item Scale for Predicting Poor Outcome Despite Successful Recanalization in Basilar Artery Occlusion

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Abstract

Poor outcome despite successful recanalization is a relatively common occurrence after endovascular therapy (EVT) in acute intracranial large vessel occlusion. We aimed to develop a simple pre-intervention scale with readily available indicators for predicting the 90-day poor outcome in acute basilar artery occlusion (BAO) patients with successful recanalization after EVT. A prospectively registered consecutive cohort of acute BAO patients treated with EVT in a tertiary stroke center during a 6-year period was reviewed. Poor outcome despite successful recanalization was defined as a 90-day mRS of > 3 despite a post-intervention mTICI of ≥ 2b. A logistic regression analysis was employed to develop the predictive scale. The performance of the scale was estimated by ROC curve and Hosmer-Lemeshow test. Poor outcome was observed in 48 of 109 patients included in this study. The proposed scale consisted of four selected pre-intervention predictors, including the NIHSS score, Pons-Midbrain Index (PMI), bilateral thalamic infarction, and Basilar Artery on Computed Tomography Angiography (BATMAN) collateral score. The 4-item scale revealed good discrimination with an area under curve of 0.83 (95% CI = 0.75–0.90) and acceptable calibration assessed by Hosmer-Lemeshow test (P = 0.48). The optimal cutoff value of the scale (range 0–5 points) was ≥ 3 points with 77% sensitivity, 80% specificity, and 79% accuracy. As a pre-intervention predictive model, the 4-item scale has promising predictive value for poor outcome despite successful recanalization in BAO patients treated with EVT. Nevertheless, external validation with blinded outcome is still needed to confirm its performance before clinical application.

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Acknowledgments

We thank all relevant clinicians, statisticians, and imaging and laboratory technicians.

Funding

This study was funded by the China Postdoctoral Science Foundation (No.2019M650773), National Key Research and Development Program of China (No.2016YFC1301501), Beijing Municipal Science & Technology Commission (No.Z18110000171837), and Hebei Provincial Health and Family Planning Commission (No.20181258 and 20181264).

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Xu Tong, Xuan Sun, Feng Gao & Zhongrong Miao

  2. Beijing Neurosurgical Institute, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Xu Tong & Wenzhi Wang

  3. Department of Continuing Education, Tangshan Vocational College of Science & Technology, Tangshan, 063000, Hebei, China

    Jiayi An

  4. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Yilong Wang

  5. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Yilong Wang

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  1. Xu Tong
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  2. Jiayi An
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  3. Xuan Sun
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Correspondence to Wenzhi Wang or Zhongrong Miao.

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The authors declare that they have no conflicts of interest.

Research Involving Human Participants and/or Animals

The study procedures were in accordance with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study. The protocol of this study had been approved by the human ethics committee of Beijing Tiantan Hospital. This article does not contain any studies with animals performed by any of the authors.

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Tong, X., An, J., Sun, X. et al. A Pre-Intervention 4-Item Scale for Predicting Poor Outcome Despite Successful Recanalization in Basilar Artery Occlusion. Transl. Stroke Res. 11, 1306–1313 (2020). https://doi.org/10.1007/s12975-020-00813-0

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  • DOI: https://doi.org/10.1007/s12975-020-00813-0

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