Age and discharge modified Rankin score are associated with 90-Day functional outcome after basilar artery occlusion treated with endovascular therapy

Abstract

Introduction Prognostic factors for functional outcome after basilar artery occlusion (BAO) treated with modern endovascular therapy (EVT) are sparse. We investigated the association between clinical characteristics, readily available imaging variables, and outcome in BAO patients treated with EVT. Methods Retrospective analysis from a large healthcare system’s prospectively collected code stroke registry of acute BAO patients treated with EVT between January 2017–January 2020. The primary outcome measure was a favorable 90-day modified Rankin score (mRS) of 0-2. Results 65 patients (median age 67 years, 57% male, median NIHSS 16) met the study inclusion criteria. Thrombolysis in Cerebral Infarction (TICI) 2 b-3 revascularization was achieved in 57/65 patients (88%) with a median time to revascularization of 445 minutes [IQR 302-840]. Ninety-day good outcome was seen in 35% (23/65) of patients. In a univariate analysis, age, history of ischemic stroke, baseline NIHSS, BAO site, and discharge mRS were associated with significant differences between the good and poor outcome groups. A multivariable logistic regression analysis demonstrated an independent association with 90-day good outcome and younger age (per 1-year, OR 0.79, 95% CI 0.64, 0.98) and good discharge mRS (0-2) (OR > 999.99, 95% CI 13.26, > 999.99). Conclusions Patients presenting with an acute BAO treated with modern EVT have a good 90-day outcome in over one-third of cases. Age and discharge mRS are independently associated with good 90-day outcome. Additional studies may focus on factors that can enhance discharge function after BAO, a novel prognostic indicator for favorable 90-day outcome in our study.

Association Between Neutrophil-to-Lymphocyte Ratio/Lymphocyte-to-Monocyte Ratio and In-Hospital Clinical Outcomes in Ischemic Stroke Treated with Intravenous Thrombolysis

“…A single center, retrospective analysis showed that mRS at discharge was similar compared with 90-d mRS in patients treated with IV tPA. 27 Discharge mRS was reported to be related to 90-d mRS. 46–48 Another retrospective study also found that NLR was a predictor of both discharge mRS and 90-d mRS in patients treated with IV tPA. 20 …”

“…As shown in Table 2, baseline characteristics comparison between mRS 0-1 group and mRS 2-6 group showed that the mRS 0-1 group had a lower proportion of bridging MT (11.11% vs 41.33%, P=0.01), lower admission NIHSS score (6.00 [3.00, 10.50] vs 9.00 [5.00, 14.00], P=0.04), lower proportion of large vessel occlusion (14.81% vs 37.33%, 2, multivariable logistics regression analyses found that NLR at 48 hours and LMR at 48 hours proved to be independent predictors of mRS 0-1 at discharge (NLR at 48 hours: crude OR=0.61, 95% CI=0. 46…”

Clinical Significance and Dynamic Change of Coagulation Parameters in Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“…In the clinical practice, the COVID-19 pandemic and population mobility in Beijing, the capital of China, made face-to-face follow-up difficult to achieve. Besides, discharge mRS was also reported to be similar and a predictor of 90-d mRS. 35 – 37 Fourth, large vessel occlusion was assessed by MRA within 24 h after IV tPA. In the real-world, only non-contrast CT scan was required before the injection of tPA to reduce the time delay.…”

Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy

“…Among the most commonly reported clinical prognostic factors are presenting stroke severity, 11–15 age, 14,15 timely revascularization, 15,16 and minimizing post‐EVT complications 14,16 . In addition, we have recently reported on the prognostic importance of discharge function on 90‐day outcome in aBAO patients treated with EVT 17 …”

“…14,16 In addition, we have recently reported on the prognostic importance of discharge function on 90-day outcome in aBAO patients treated with EVT. 17 In addition to clinical factors, several posterior circulation imaging scoring systems have been developed [18][19][20] that have been linked to functional outcome after stroke. 12,[18][19][20][21][22][23][24][25][26][27][28] The posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS), analogous to the Alberta Stroke Program Early CT Score for the middle cerebral artery (MCA) territory, 18 has shown prognostic ability for functional outcome when applied to CT angiogram source images (CTA-SI), 18,21 diffusion weighted imaging (DWI) MRI, 12,[22][23][24] and CT perfusion (CTP) cerebral blood volume (CBV).…”