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A New Angiographic Collateral Grading System for Acute Basilar Artery Occlusion Treated with Endovascular Therapy

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Abstract

Poor clinical outcomes despite endovascular therapy (EVT) are common in patients with acute basilar artery occlusion (BAO). We aimed to develop a new angiographic collateral grading system for predicting 90-day functional outcomes of acute BAO after EVT. A prospectively registered consecutive cohort of acute BAO patients treated with EVT in our center during a 6-year period was reviewed. The angiographic collateral grading system for BAO (ACGS-BAO) included 4 grades for poor (grade 1–2), intermediate (grade 3), and good (grade 4) collateral statuses. First, the independent association of ACGS-BAO with 90-day functional independence (mRS ≤ 2), favorable outcome (mRS ≤ 3), and death was evaluated by multivariable logistic regression model; then, the heterogeneity in the effects of ACGS-BAO on 90-day outcomes was explored among the subgroups stratified by age, time window, stroke severity, and etiology. Finally, the interobserver agreement of ACGS-BAO was assessed by weighted kappa statistic. Of 173 patients included in this study, 62 (35.8%), 83 (48.0%), and 36 (20.8%) achieved 90-day functional independence, favorable outcome, and death, respectively. Multivariable logistic analyses showed that ACGS-BAO was independently associated with functional independence (OR = 2.07, 95% CI = 1.05–4.07) and favorable outcome (OR = 1.84, 95% CI = 1.02–3.43) but not related to death (OR = 0.78, 95% CI = 0.37–1.64). Similar effects of ACGS-BAO on 90-day outcomes were seen across all subgroups (P > 0.10 for all interactions). The interobserver agreement of ACGS-BAO was very high (weighted kappa = 0.96, 95% CI = 0.93–0.99). The ACGS-BAO is an angiographic tool with excellent interobserver reliability that can be used to predict the 90-day outcome of acute BAO treated by EVT. Nevertheless, our findings are still needed to be confirmed in a prospective multicenter study before clinical application.

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Acknowledgments

We would like to thank patients, clinical staff, imaging, and laboratory technicians for their contribution to this study. We also would like to thank Dr. WaiTing Joyce Lo (Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China) and Dr. Trilochan Srivastava (Department of Neurology, SMS Medical College, Jaipur, India) for their generous input on language editing.

Funding

This study was funded by the Beijing Municipal Science & Technology Commission (No. Z18110000171837), China Postdoctoral Science Foundation (No. 2019M650773), National Key Research and Development Program of China (No. 2016YFC1301500), and Hebei Provincial Health and Family Planning Commission (No. 20181258).

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  1. Feng Gao and Xu Tong contributed equally to this work.

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

    Feng Gao, Xu Tong, Xuan Sun & Zhongrong Miao

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  1. Feng Gao
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Correspondence to Feng Gao or Zhongrong Miao.

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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 our institutional review board. This article does not contain any studies with animals performed by any of the authors.

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Gao, F., Tong, X., Sun, X. et al. A New Angiographic Collateral Grading System for Acute Basilar Artery Occlusion Treated with Endovascular Therapy. Transl. Stroke Res. 12, 559–568 (2021). https://doi.org/10.1007/s12975-020-00856-3

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