Prognosis of acute tandem vertebrobasilar artery occlusion after endovascular revascularization: report of 647 cases

Abstract

Objective To analyze the prognosis and risk factors of acute tandem vertebrobasilar artery occlusion (VBO) after endovascular therapy (EVT). Methods This study used the patient data from the EVT for Acute Basilar Artery Occlusion Study (BASILAR), a national multicenter clinical registry study for endovascular treatment of acute basilar artery occlusion from January 2014 to May 2019. All patients received intravascular treatment and underwent a 90 d follow-up. According to the presence of vertebral artery and basilar artery occlusion, they were divided into vertebral basilar artery occlusion (VBO) group and acute basilar artery occlusion (BAO) group. Their baseline indicators were analyzed to explore the differences in prognosis and influencing factors between the 2 groups. Results A total of 647 eligible patients were included in this study, with a median age of 64 (56, 74) years, and 74.7% of them (483) were males. Among them, 560 patients had simple basilar artery occlusion and the other 87 had basilar artery occlusion combined with severe stenosis or occlusion of the vertebral artery. There were no significant differences in the 90-day good prognosis rate (defined as mRS score of 0~3) (P=0.090) and mortality rate (P=0.890) between the VBO group and the BAO group. For the patients in the VBO group, lower NIHSS score (OR=0.898, 95% CI: 0.845~0.954, P < 0.001), higher pc-ASPECTS score (OR=1.690, 95%CI: 1.117~2.557, P=0.010), and shorter puncture to recanalization time (OR=0.990, 95%CI: 0.980~1.000, P=0.047) were independent risk factors for 90-day good prognosis. Similarly, higher NIHSS score (OR=1.094, 95%CI: 1.033~1.159, P=0.002), lower pc-ASPECTS score (OR=0.622, 95%CI: 0.438~0.882, P=0.008) and longer puncture to recanalization time (OR=1.010, 95%CI: 1.001~1.019, P=0.040) were also predictive factors for 90-day mortality in these patients. Conclusion EVT is safe and effective for acute VBO, with a good short-term prognosis. NIHSS score, pc-ASPECTS score, and puncture to recanalization time are independent predictors for 90-day good prognosis in VBO patients, and are also predictors of 90-day mortality rate.

Keywords

• endovascular therapy
• basilar artery
• tandem occlusion
• good prognosis
• mortality