Predictors of Very Poor Outcome after Mechanical Thrombectomy for Acute Basilar Artery Occlusion

Abstract

Prognosis for patients with acute basilar artery occlusion (BAO) remains poor. Successful revascularization is a main predictor of favorable clinical outcomes after mechanical thrombectomy for BAO. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome, including vegetative state and mortality. This study investigated the factors that are predictive of extremely poor clinical outcomes despite successful revascularization after mechanical thrombectomy for BAO. We evaluated 35 consecutive patients who presented with acute ischemic stroke due to BAO and who were successfully treated with mechanical thrombectomy. A very poor outcome was defined as a modified Rankin Scale (mRS) score of 5 or 6 at 3 months after treatment. The associations between the clinical, imaging, procedural factors, and poor outcome were evaluated. Using univariate analyses, there were significant differences in the preoperative National Institute of Health Stroke Scale (NIHSS) score (22.0 ± 9.0 vs. 30.5 ± 4.3, p <0.001), and infarct volume in brain stem (0.11 ± 0.19 cc vs. 2.55 ± 1.56 cc, p <0.001) between the control and very poor outcome groups. In receiver operating characteristic (ROC) curve analysis, the area under ROC curve of infarct volume in brain stem was 0.891 to predict very poor outcome. Preoperative infarct volume in brain stem is strong predictor for very poor outcome. The infarct volume in brain stem is useful for deciding treatment indications.

DWI-Based Radiomics Predicts the Functional Outcome of Endovascular Treatment in Acute Basilar Artery Occlusion

“…Li et al 33 found that the maximum length multiplied by thickness in the brainstem may be a predictor for assessing neurologic deterioration. Consistent with our findings, Liu et al 34 and Tajima et al 35 found significantly reduced infarct volumes from the midbrain and pons and that increased caudate volumes had favorable clinical outcomes in patients after EVT. Mourand et al 36 showed that pre-EVT cerebellar infarct volume was an independent predictor of 90-day functional independence.…”

“…The occipital cortex, thalamus, and cerebellum lesions are less involved in functional outcome than those in the brainstem. 35 The numerous key conduction systems that maintain consciousness and physiologic activities cross the brainstem. 37 This may explain the worse clinical outcome of infarcts in the brainstem region.…”

Prognostic Value of Different Imaging Scores Based on CTA in Endovascular Treatment of Acute Basilar Artery Occlusion

“…19 Baseline NIHSS score is an independent factor for postoperative outcomes, and a lower NIHSS score predicts a better prognosis for patients. 20,21 This study has some limitations. On the one hand, as a single-centre study, the sample size is relatively small.…”

Clinical Predictors for Early Mortality of Patients with Acute Basilar Artery Occlusion

“…Previous studies have demonstrated that several independent factors were associated with in-hospital mortality in patients with anterior circulation large vessel occlusion [4, 5, 8]. However, few studies have established the factors which independently increase the risk of early mortality in BAO, a disorder associated with the highest mortality rate among causes of stroke [19, 20]. The majority of deaths in the first week are due to herniation, hemorrhage, and cerebral infarction according to a previous study [4].…”