Prognostic factors for acute vertebrobasilar artery occlusion-reperfusion: A multicenter retrospective cohort study

Abstract

Background: This study aimed to analyze the long-term prognostic factors in acute vertebrobasilar artery occlusion (VBAO) patients treated with endovascular treatment (EVT). Methods: This study was performed using the acute posterior circulation ischemic stroke registry database from 21 stroke centers in 18 cities in China and retrospectively included consecutive patients aged 18 years or older with an acute, symptomatic, radiologically confirmed VBAO who were treated with EVT between December 2015 and December 2018. Favorable clinical outcomes were evaluated by machine-learning methods. A clinical signature was constructed in the training cohort using the least absolute shrinkage and selection operator regression and was validated in the validation cohort. Results: From 28 potential factors, 7 variables were independent prognostic factors and were included in the model: Modified Thrombolysis in Cerebral Infarction (M) [odds ratio (OR): 2.900; 95% confidence interval [CI]: 1.566–5.370], age (A) (OR, 0.977; 95% CI: 0.961–0.993), National Institutes of Health Stroke Scale (N) (13–27 vs. ≤12: OR, 0.491; 95% CI: 0.275–0.876; ≥28 vs. ≤12: OR, 0.148; 95% CI: 0.076–0.289), atrial fibrillation (A) (OR, 2.383; 95% CI: 1.444–3.933), Glasgow Coma Scale (G) (OR, 2.339; 95% CI: 1.383–3.957), endovascular stent-retriever thrombectomy (E) (stent-retriever vs. aspiration: OR, 0.375; 95% CI: 0.156–0.902), and estimated time of onset of the occlusion to groin puncture (Time) (OR, 0.950; 95% CI: 0.909–0.993) (abbreviated as MANAGE Time). In the internal validation set, this model was well calibrated with good discrimination [C-index (95% CI)=0.790 (0.755–0.826)]. A calculator based on the model can be found online (http://ody-wong.shinyapps.io/1yearFCO/). Conclusion: Our results indicate that optimizing for EVT, along with specific risk stratification, may improve long-term prognosis. However, a larger prospective study is needed to confirm the findings.