Predictors of Good Outcome After Endovascular Treatment for Patients with Vertebrobasilar Artery Occlusion due to Intracranial Atherosclerotic Stenosis

Abstract

Purpose

To investigate the predictors for good outcome of endovascular therapy (EVT) for patients with acute vertebrobasilar artery occlusion (VBAO) due to intracranial atherosclerosis stenosis (ICAS).

Methods

From April 2012 to February 2018, patients with VBAO due to ICAS who received EVT were retrospectively analyzed. ICAS was defined as fixed stenosis of >70%, or a degree of fixed stenosis >50% in addition to either perfusion impairment or evidence to re-occlusion. Good outcome was defined as mRS≤2 at 90 days. Both logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the predictors.

Results

Among 103 patients enrolled in the analysis, 40.8% achieved good outcome. Prior antiplatelet therapy (OR, 7.301; 95% CI, 1.761–30.265; P=0.006), EVT+IVT (OR, 7.343; 95% CI, 1.621–33.263; P=0.010 ), the pc-ASPECT on DWI (OR, 1.705; 95% CI, 1.127–2.580; P=0.012), BATMAN (OR, 1.395; 95% CI, 1.005–1.937; P=0047), general anesthesia (OR, 0.081; 95% CI, 0.010–0.633; P=0.017), onset-to-recanalization time (≤542min vs. >542min) (OR, 0.194; 95% CI, 0.057–0.661; P=0.009) and the initial NIHSS (OR, 0.882; 95% CI, 0.820–0.949; P=0.001) were significantly associated with good outcome in logistic regression. Based on ROC analyses, initial NIHSS score (area under the curve [AUC]= 0.816, p <0.001; cutoff,19.5; sensitivity, 78.7%; specificity, 72.5%) was significant predictors of good outcome.

Conclusions

For patients with VBAO due to ICAS, prior antiplatelet therapy, EVT+IVT, local anesthesia, short onset-to-recanalization time, a low initial NIHSS, a high pc-ASPECT and BATMAN might be helpful to predict the good outcome at 90 days after EVT.

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Acknowledgements

The authors thank all the clinicians, imaging and laboratory technicians, and statisticians who contributed to the information collection and analysis of this study. The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Correspondence to Zhongrong Miao.

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X. Zhang, G. Luo, D. Mo, N. Ma, F. Gao, J Zhang and Z. Miao declare that they have no competing interests.

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Zhang, X., Luo, G., Mo, D. et al. Predictors of Good Outcome After Endovascular Treatment for Patients with Vertebrobasilar Artery Occlusion due to Intracranial Atherosclerotic Stenosis. Clin Neuroradiol 29, 693–700 (2019). https://doi.org/10.1007/s00062-018-0731-z

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Keywords

  • Acute ischemic stroke
  • Thrombectomy
  • Antiplatelet therapy
  • Pc-ASPECT
  • BATMAN