Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion

Fellows’ Journal Club

The authors analyzed consecutive MR imaging–selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b–3 and 3, respectively. Outcome at 90 days was analyzed. One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases. At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes. In this series of MR imaging–selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome.

Abstract

BACKGROUND AND PURPOSE

Clinical outcomes after endovascular treatment for acute basilar artery occlusions need further investigation. Our aim was to analyze predictors of a 90-day good functional outcome defined as mRS 0–2 after endovascular treatment in MR imaging–selected patients with acute basilar artery occlusions.

MATERIALS AND METHODS

We analyzed consecutive MR imaging–selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b–3 and 3, respectively. Outcome at 90 days was analyzed in univariate and multivariate analysis regarding baseline patient treatment characteristics and periprocedural outcomes.

RESULTS

One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases (n = 90; 95% CI, 73.3%–88.6%). At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes (interquartile range, 280–540 minutes). In multivariable analysis, complete reperfusion (OR = 6.59; 95% CI, 2.17–20.03), lower pretreatment NIHSS (OR = 0.77; 95% CI, 0.64–0.94), the presence of posterior communicating artery collateral flow (OR = 2.87; 95% CI, 1.05–7.84), the absence of atrial fibrillation (OR = 0.18; 95% CI, 0.03–0.99), and intravenous thrombolysis administration (OR = 2.75; 95% CI, 1.04–7.04) were associated with 90-day favorable outcome.

CONCLUSIONS

In our series of MR imaging–selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome.

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