Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion

Abstract

Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups.Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in the MM group.Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N = 66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.5 [95% confidence interval (CI), 1.4–154.4]) and reperfusion failure (eTICI < 2b67 (OR, 5.0 [95% CI, 1.3–19.9]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.5 [95% CI, 1.1–2.0]), stroke onset-to-door time <24 h (OR, 5.3 [95% CI, 1.1–2.0]), near-total occlusions (OR, 4.9 [95% CI, 1.2–19.6]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6 [95% CI, 1.0–2.5]), and lower BATMAN collateral scores (OR, 1.6 [95% CI, 1.1–2.2]) were predictive of END-IP.Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In the primary EVT group, failure to achieve reperfusion and distal basilar occlusion were associated with all-cause END. In the MM group, higher SBP at presentation, onset-to-door time less than 24 h, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.

Risk factors and prognosis of early neurological deterioration in patients with posterior circulation cerebral infarction

“…The incidence of END in PCIS ranged from 5.1-28.57% in previous studies [2,6,14,15], in which the risk of END increased in patients with single small infarcts and vertebrobasilar occlusion [2,14]. Compared with non-END patients, this study found that a higher baseline NIHSS score was associated with the occurrence of END, which was consistent with the results of previous studies[6, 14,15].…”

“…In patients with acute subcortical small infarction (SSI) in the vertebrobasilar artery perforator territory, proximal SSI was signi cantly associated with END, which was explained by focal thrombus, hemodynamic instabilityrelated progressive shedding of unstable plaque covering the vessel, poor collateral circulation, or acute in ammation or secondary edema [14]. Large artery atherosclerosis (LAA) was not associated with END in a study on patients with vertebrobasilar occlusion [2]. However, LAA was found to be associated with END in the acute ischemic stroke population[8], and a multicenter study identi ed intracranial atherosclerosis as a risk factor for PCIS [19].…”

“…Patients with acute posterior circulation ischemic stroke may experience early neurological deterioration (END), resulting in a signi cant increase in disability and mortality [1,2]. It has been con rmed that END is signi cantly associated with ischemic progression [3,4]; symptomatic intracranial hemorrhage and malignant edema may also be key factors [5].…”

Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke

“…Third, there still remains a gap between minor AVS/AIS group and prodromal vertigo group, as END was infrequent in minor AVS/AIS. Thus, in future studies, risk factors of END in minor AVS/AIS should be identified, such as incomplete occlusions or distal basilar involvements that have predicted END in vertebrobasilar occlusions ( 50 , 51 ).…”

Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy

“…This issue is important because the END rate in patients with VBAO was over 30% in those with a low NIHSS score in a retrospective study [ 34 ]. However, data regarding predictors of END are limited, and potential factors predictive of END that need to be validated include high blood pressure, shorter onset-to-door times, incomplete occlusions, larger infarct cores, and poorer collaterals [ 35 ].…”