The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Abstract

Background: The mortality of acute ischemic stroke patients caused by vertebrobasilar artery occlusion (VBAO) is high and mechanical thrombectomy has gradually become a promising treatment for acute ischemic stroke. This study analyzed the efficacy of mechanical thrombectomy and the risk factors associated with poor outcomes in VBAO patients caused by severe local atherosclerotic stenosis.Methods: This retrospective study enrolled patients with acute ischemic stroke caused by VBAO between March 1, 2016 and August 31, 2019. Patient demographic and clinical data were collected retrospectively. All enrolled patients were retrospectively interviewed for at least 3 months. Patients with a modified Rankin scale (mRS) score between 0 and 3 points were defined as having satisfactory outcomes while those with more than 3 points were defined as having unsatisfactory outcomes. In-hospital mortality, the rates of recanalization, and the rates of intracerebral hemorrhage were also recorded. Multivariable logistic regression was used to determine the risk factors of unsatisfactory outcomes in enrolled patients.Results: A total of 65 patients were enrolled in this study with a median age 69.0 (63.0-78.0) years and 48 patients (73.8%) were male. Approximately 50% of patients had a mRS score of 0 or 1 point within 90 days after treatment with mechanical thrombectomy and 14 patients had a mRS score of 6 points. A total of 11 patients died in hospital. Out of the 65 patients, 7 required recanalization and 9 patients suffered from intracerebral hemorrhage. Multivariate logistic regression analysis showed that older age, lower baseline posterior circulation acute stroke prognosis early CT score (pcASPECTS), higher baseline National Institutes of Health stroke scale (NIHSS) score, and residual stenosis were independent risk factors of both unsatisfactory outcomes and mortality of VBAO patients.Conclusions: This study confirmed the important role of mechanical thrombectomy in the treatment of acute ischemic stroke caused by VBAO and may provide some guidance for improving the prognosis of patients.

Dynamic and visual nomograms to online predict unfavorable outcome of mechanical thrombectomy for acute basilar artery occlusion

“…Consistent with previous studies, this study confirmed that the pc‐ASPECTS score was correlated with MT outcome (Alemseged et al., 2019 ; Sang et al., 2021 ; Wu et al., 2021 ; Yao et al., 2021 ). A previous study with a large sample size revealed that patients with pc‐ASPECTS ≥5 could benefit from MT (Sang et al., 2021 ), while another small sample study showed pc‐ASPECTS ≥8 was the boundary (Alemseged et al., 2019 ; Fabritius et al., 2021 ).…”

“…So far, several studies have evaluated the prognostic factors of MT in BAO. They all used multivariable logistical regression models to ascertain the potential predictors (Alexandre et al., 2021 ; Bouslama et al., 2017 ; Diprose et al., 2020 ; Fabritius et al., 2021 ; Guenego et al., 2021 ; Kwak & Park, 2020 ; Mokin et al., 2016 ; Sang et al., 2021 ; Wu et al., 2021 ; Wu, Xu et al., 2021 ; Yao et al., 2021 ). In this study, we constructed separate pre‐ and postoperative nomogram models to conduct a comprehensive evaluation.…”

“…The association between a high NIHSS score and the risk of an unfavorable outcome was fully demonstrated (Alexandre et al, 2021;Bouslama et al, 2017;Kwak & Park, 2020;Szmygin et al, 2021;Yao et al, 2021). In the studies of ACS, the baseline NIHSS was approximately 17 (Campbell et al, 2015).…”

“…Early prediction of outcomes in BAO patients treated with MT could identify the appropriate patient for MT and provide individual management after stroke. Previous studies have revealed that some factors, such as stroke severity and the success of the operation, were associated with the functional outcome of MT in BAO (Kwak & Park, 2020;Yao et al, 2021;Zhang et al, 2019). So far, no prediction models have been developed to conduct a comprehensive evaluation.…”

A visualized nomogram to online predict futile recanalization after endovascular thrombectomy in basilar artery occlusion stroke

“…Generally, age and the NIHSS were recognized to be a predictor of prognosis in BAO stroke (3,18). As shown in Table 2, the higher NIHSS on admission was significantly associated with a higher rate of futile recanalization in the present study.…”