Skip to main content
SpringerLink
Log in

Predictors of poor outcome after endovascular treatment for acute vertebrobasilar occlusion: data from ANGEL-ACT registry

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

A Correction to this article was published on 09 November 2022

This article has been updated

Abstract

Purpose

Acute vertebrobasilar artery occlusion (VBAO) is a catastrophic disease for patients. There is evidence that the eventual patient outcome depends on patient-specific and procedural factors. This study aimed to identify the incidence and independent predictors of the 90-day poor outcome in VBAO after endovascular treatment (EVT).

Methods

Subjects were selected from the ANGEL-ACT registry. The 90-day poor outcome was defined as a 90-day modified Rankin Scale (mRS) of 4 to 6. Logistic regression analyses were performed to determine the independent predictors of the 90-day poor outcome.

Results

Of the 347 enrolled patients with acute VBAO undergoing EVT, 176 (50.7%) experienced the 90-day poor outcome. Multivariate logistic regression indicated that only the use of general anesthesia (GA) (odds ratio [OR] = 2.04; 95% confidence interval [CI], 1.23–3.37; P = 0.006) and heparin during the procedure (OR =1.74; 95% CI, 1.06–2.86; P = 0.028), admission National Institute of Health Stroke Scale (NIHSS) ≥ 26 (OR=3.96; 95% CI, 2.37–6.61; P < 0.001), and time from onset to puncture (OTP) ≥ 395 min (OR=1.91; 95% CI, 1.14–3.20; P = 0.014) and procedure duration ≥ 102 min (OR = 1.70; 95% CI, 1.04–2.79; P = 0.036) were independent predictors of the 90-day poor outcome after EVT. Furthermore, admission NIHSS (OR > 36 vs. ≤ 11 = 9.01, P for trend < 0.001), OTP (OR > 441min vs. ≤ 210 min = 2.71, P for trend = 0.023), and procedure duration (OR > 145 min vs. ≤ 59 min = 2.77, P for trend = 0.031) were significantly associated with increasing risk of the 90-day poor outcome.

Conclusions

Poor outcome after EVT at 90 days occurred in 50.7% of acute VBAO patients from the ANGEL-ACT registry. Our study found several predictors of the 90-day poor outcome which should be highly considered in daily practice to improve acute VBAO management.

Clinical Trial Registration 

http://www.clinicaltrials.gov. Unique identifier: NCT03370939

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author Zhongrong Miao upon reasonable request.

Change history

References

  1. Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ (2005) Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry 76(9):1238–1241

    Article  Google Scholar 

  2. Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, Engelter ST, Tanne D, Muir KW, Molina CA et al (2009) Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 8(8):724–730

    Article  Google Scholar 

  3. Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie C et al (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 17(1):47–53

    Article  Google Scholar 

  4. Liu X, Dai Q, Ye R, Zi W, Liu Y, Wang H, Zhu W, Ma M, Yin Q, Li M et al (2020) Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 19(2):115–122

    Article  Google Scholar 

  5. Langezaal LCM, van der Hoeven E, Mont’Alverne FJA, de Carvalho JJF, Lima FO, Dippel DWJ, van der Lugt A, Lo RTH, Boiten J, Lycklama ANGJ et al (2021) Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med 384(20):1910–1920

    Article  Google Scholar 

  6. Writing Group for the BG, Zi W, Qiu Z, Wu D, Li F, Liu H, Liu W, Huang W, Shi Z, Bai Y et al (2020) Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurol 77(5):561–573

    Article  Google Scholar 

  7. Lee SJ, Hong JM, Kim JS, Lee JS (2022) Endovascular treatment for posterior circulation stroke: ways to maximize therapeutic efficacy. J Stroke 24(2):207–223

    Article  Google Scholar 

  8. Jia B, Ren Z, Mokin M, Burgin WS, Bauer CT, Fiehler J, Mo D, Ma N, Gao F, Huo X et al (2021) Current status of endovascular treatment for acute large vessel occlusion in China: a real-world nationwide registry. Stroke 52(4):1203–1212

    Article  Google Scholar 

  9. Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O’Reilly C, Barber PA et al (2008) Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 39(9):2485–2490

    Article  Google Scholar 

  10. Lee JS, Hong JM, Lee KS, Suh HI, Demchuk AM, Hwang YH, Kim BM, Kim JS (2015) Endovascular therapy of cerebral arterial occlusions: intracranial atherosclerosis versus embolism. J Stroke Cerebrovasc Dis : Off J Natl Stroke Assoc 24(9):2074–2080

    Article  Google Scholar 

  11. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL et al (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44(9):2650–2663

    Article  Google Scholar 

  12. von Kummer R, Broderick JP, Campbell BC, Demchuk A, Goyal M, Hill MD, Treurniet KM, Majoie CB, Marquering HA, Mazya MV et al (2015) The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 46(10):2981–2986

    Article  Google Scholar 

  13. Wouters A, Nysten C, Thijs V, Lemmens R (2018) Prediction of outcome in patients with acute ischemic stroke based on initial severity and improvement in the first 24 h. Front Neurol 9:308

    Article  Google Scholar 

  14. Yoon W, Kim SK, Heo TW, Baek BH, Lee YY, Kang HK (2015) Predictors of good outcome after stent-retriever thrombectomy in acute basilar artery occlusion. Stroke 46(10):2972–2975

    Article  Google Scholar 

  15. Schonenberger S, Uhlmann L, Hacke W, Schieber S, Mundiyanapurath S, Purrucker JC, Nagel S, Klose C, Pfaff J, Bendszus M et al (2016) Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA 316(19):1986–1996

    Article  Google Scholar 

  16. Lowhagen Henden P, Rentzos A, Karlsson JE, Rosengren L, Leiram B, Sundeman H, Dunker D, Schnabel K, Wikholm G, Hellstrom M et al (2017) General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the AnStroke Trial (anesthesia during stroke). Stroke 48(6):1601–1607

    Article  Google Scholar 

  17. Simonsen CZ, Yoo AJ, Sorensen LH, Juul N, Johnsen SP, Andersen G, Rasmussen M (2018) Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol 75(4):470–477

    Article  Google Scholar 

  18. Schonenberger S, Henden PL, Simonsen CZ, Uhlmann L, Klose C, Pfaff JAR, Yoo AJ, Sorensen LH, Ringleb PA, Wick W et al (2019) Association of general anesthesia vs procedural sedation with functional outcome among patients with acute ischemic stroke undergoing thrombectomy: a systematic review and meta-analysis. JAMA 322(13):1283–1293

    Article  Google Scholar 

  19. Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Davalos A, Majoie C et al (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 17(1):47–53

    Article  Google Scholar 

  20. Pop R, Severac F, Happi Ngankou E, Harsan O, Martin I, Mihoc D, Manisor M, Simu M, Chibbaro S, Wolff V et al (2021) Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis. J Neurointerv Surg 13(3):207–211

    Article  Google Scholar 

  21. Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. JAMA 1998, 279(16):1265-1272

  22. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet 1997, 349(9065):1569-1581

  23. Yang M, Huo X, Gao F, Wang A, Ma N, Liebeskind DS, Wang Y, Miao Z (2019) Safety and efficacy of heparinization during mechanical thrombectomy in acute ischemic stroke. Front Neurol 10:299

    Article  Google Scholar 

  24. van der Steen W, van de Graaf RA, Chalos V, Lingsma HF, van Doormaal PJ, Coutinho JM, Emmer BJ, de Ridder I, van Zwam W, van der Worp HB et al (2022) Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial. Lancet 399(10329):1059–1069

    Article  Google Scholar 

  25. Chueh JY, Kuhn AL, Puri AS, Wilson SD, Wakhloo AK, Gounis MJ (2013) Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. Stroke 44(5):1396–1401

    Article  Google Scholar 

  26. Bouslama M, Haussen DC, Aghaebrahim A, Grossberg JA, Walker G, Rangaraju S, Horev A, Frankel MR, Nogueira RG, Jovin TG et al (2017) Predictors of good outcome after endovascular therapy for vertebrobasilar occlusion stroke. Stroke 48(12):3252–3257

    Article  Google Scholar 

  27. Mokin M, Sonig A, Sivakanthan S, Ren Z, Elijovich L, Arthur A, Goyal N, Kan P, Duckworth E, Veznedaroglu E et al (2016) Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke 47(3):782–788

    Article  Google Scholar 

  28. Singer OC, Berkefeld J, Nolte CH, Bohner G, Haring HP, Trenkler J, Groschel K, Muller-Forell W, Niederkorn K, Deutschmann H et al (2015) Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 77(3):415–424

    Article  Google Scholar 

  29. Hassan AE, Shariff U, Saver JL, Goyal M, Liebeskind D, Jahan R, Qureshi AI (2019) Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment. J Neurointerv Surg 11(10):984–988

    Article  Google Scholar 

  30. Spiotta AM, Vargas J, Turner R, Chaudry MI, Battenhouse H, Turk AS (2014) The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg 6(7):511–516

    Article  Google Scholar 

  31. Kass-Hout T, Kass-Hout O, Sun CJ, Kass-Hout TA, Nogueira R, Gupta R (2016) Longer procedural times are independently associated with symptomatic intracranial hemorrhage in patients with large vessel occlusion stroke undergoing thrombectomy. J Neurointerv Surg 8(12):1217–1220

    Article  Google Scholar 

  32. García-Tornel Á, Requena M, Rubiera M, Muchada M, Pagola J, Rodriguez-Luna D, Deck M, Juega J, Rodríguez-Villatoro N, Boned S et al (2019) When to stop. Stroke 50(7):1781–1788

    Article  Google Scholar 

Download references

Acknowledgements

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

Funding

This study was funded by the National Key Research and Development Program of China, grant number 2016YFC1301500.

Author information

Authors and Affiliations

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

    Dapeng Sun, Xiaochuan Huo,  Raynald, Baixue Jia, Xu Tong, Gaoting Ma, Dapeng Mo, Feng Gao, Ning Ma & Zhongrong Miao

  2. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Anxin Wang

Authors
  1. Dapeng Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaochuan Huo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raynald
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anxin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Baixue Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xu Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gaoting Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dapeng Mo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Feng Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ning Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhongrong Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhongrong Miao.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

This study was approved by the ethics committees of Beijing Tiantan Hospital, Capital Medical University. The ID of the approval is KY2017-048-01.

Consent to participate

Subjects or their legally authorized representatives provided written informed consent prior to commencing the study.

Consent for publication

All authors give consent to publish.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Originally, the article was published with error. In Figure 1, the total number of patients who were excluded should be 1446 but the number in the online article was 510. Figure 1 is now correctly modified.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, D., Huo, X., Raynald et al. Predictors of poor outcome after endovascular treatment for acute vertebrobasilar occlusion: data from ANGEL-ACT registry. Neuroradiology 65, 177–184 (2023). https://doi.org/10.1007/s00234-022-03065-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-022-03065-x

Keywords

Search

Navigation