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Factors influencing early neurological improvement after mechanical thrombectomy among patients with acute basilar artery occlusion: a single center prospective observational cohort study

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Abstract

The predictive value of and the influencing factors associated with early neurological improvement (ENI) among patients with acute basilar artery occlusion (BAO) have not been well studied. The present study aimed to evaluate whether ENI predicted a better functional outcome and to identify the influencing factors of ENI. We performed a prospective observational analysis among 187 patients with acute BAO who underwent endovascular treatment (EVT) in Beijing Tiantan Hospital from January 2012 to July 2018. ENI was defined as having a drop on the National Institutes of Health Stroke Scale (NIHSS) by 8 or more scores or having a NIHSS of 0–1 within 24 h after EVT. A multivariate logistic regression model with backward selection was used to identify the influencing factors associated with ENI. ENI had a sensitivity of 0.69 and a specificity of 0.68 to predict a favorable outcome at 90 days after EVT. In addition, patients with ENIs had lower modified Rankin Scale score (mRS) (median: 2.0 vs. 5.0, p < 0.001) and were more likely to survive (95.2% vs. 72.0%, p < 0.001) and achieve functional independence (74.2% vs. 36.8%, p < 0.001). NIHSS before EVT, complete recanalization, white blood cell counts and general anesthetics were significant factors associated with ENI. A one-unit higher NIHSS and complete recanalization were associated with 1.04 (95% CI 1.01–1.08) and 2.71 (95% CI 1.14–6.45) times higher odds of achieving ENI, respectively. In conclusion, in patients with acute BAO, ENI within 24 hours after EVT can predict favorable outcomes at 90 day. Patients with higher NIHSS, lower white blood cell counts before surgery, without general anesthetics and patients with complete recanalization were more likely to achieve ENIs.

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Funding

This work was supported by the National Key Research and Development Program of China (2016YFC1301501) and Beijing Municipal Science & Technology Commission (No. Z18110000171837). All the authors disclosed no financial relationships relevant to this study.

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Author notes

  1. First authors: Xuan Sun and Zhongrong Miao

Authors and Affiliations

  1. Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China

    Xuan Sun, Xu Tong, Feng Gao, Yiming Deng, Gaoging Ma, Ning Ma, Dapeng Mo, Ligang Song, Lian Liu, Xiaochuan Huo & Zhongrong Miao

  2. Department of Neurology, Tong Ren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China

    Huijun Zhang

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  1. Xuan Sun
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  3. Xu Tong
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XS, HZ and XT. The first draft of the manuscript was written by XS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zhongrong Miao.

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The authors declare that they have no conflict of interests.

Ethical approval

Approval was obtained from the ethics committee of Beijing Tiantan Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data.

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Sun, X., Zhang, H., Tong, X. et al. Factors influencing early neurological improvement after mechanical thrombectomy among patients with acute basilar artery occlusion: a single center prospective observational cohort study. J Thromb Thrombolysis 51, 180–186 (2021). https://doi.org/10.1007/s11239-020-02153-0

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