Predictors of favorable outcomes for vertebrobasilar artery occlusion after endovascular therapy within 24 hours of symptom onset.

Abstract

OBJECTIVE:

The aim of the present study was to describe our results of endovascular therapy (EVT) for vertebrobasilar artery occlusion (VBAO) within 24 h of symptom onset, and to evaluate prognostic factors associated with favorable outcomes.

METHODS:

The present study enrolled patients who underwent EVT for acute ischemic stroke (AIS) caused by VBAO. Inclusion criteria for EVT to treat VBAO were as follows: (1) computed tomography angiography (CTA) or magnetic resonance angiography (MRA) confirmed acute VBAO; (2) baseline National Institutes of Health Stroke Scale (NIHSS) score ≥2; (3) premorbid modified Rankin scale (mRS) score ≤2; (4) onset or last known time to puncture within 24 h; and (5) posterior-circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) ≥6. Favorable outcomes were defined as mRS scores of 0-3 at three months following EVT. The associations among baseline parameters, procedural parameters, and favorable outcomes were assessed.

RESULTS:

A total of 67 patients were recruited in this study, of which 40 patients (59.7 %) had favorable outcomes. Of the 50 patients with a late-window (6-24 h), 29 patients (58 %) had favorable outcomes. Univariate analysis revealed significant associations of the following parameters with favorable outcomes in the enrolled patients: age, sex, smoking status, baseline NIHSS score, baseline Glasgow coma scale (GCS) score, Pons-midbrain index (PMI), and intracranial atherosclerosis (ICAS). Multivariate logistic regression indicated that only age (OR 0.914, 95 % CI: 0.849 to 0.984; p = 0.017), baseline GCS score (OR 1.234, 95 % CI: 1.061-1.435; p = 0.006), and PMI (OR 0.448, 95 % CI: 0.252 to 0.798; p = 0.006) were independently associated with favorable outcomes at three months following EVT. After adjustments for confounding factors in patients with a late-window, only age (OR 0.879, 95 % CI: 0.799 to 0.967; p = 0.008) was associated with favorable outcomes.

CONCLUSIONS:

Younger age, lower PMI, and higher GCS scores in patients with VBAO-induced AIS were associated with more favorable outcomes. In late-window (6-24 h) patients, younger age associated to favorable outcomes, and lower NIHSS scores and lower PMI each also had a tendency to associated with favorable outcomes.

• Authors: Changchun Jiang, Yu Fan, Yuechun Li, Fei Hao, Junfeng Yang, Baojun Wang, Tianyou Zhang, Xia Li, Jiahui Liu, Shuguang Wang
• Journal: Clinical neurology and neurosurgery (Clin Neurol Neurosurg) Vol. 201 Pg. 106422 (02 2021) ISSN: 1872-6968 [Electronic] Netherlands
• PMID: 33340841 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Topics

• Aged
• Arterial Occlusive Diseases (complications, surgery)
• Arteries (surgery)
• Brain Ischemia (complications, surgery)
• Endovascular Procedures (methods)
• Female
• Humans
• Male
• Middle Aged
• Prognosis
• Stroke (diagnosis, surgery)
• Thrombolytic Therapy (methods)
• Vertebrobasilar Insufficiency (surgery)