Analysis of influence factors for unfavorable prognosis in acute basilar artery occlusion treated with endovascular thrombectomy

Objective To screen the risk factors related to unfavorable prognosis and evaluate the predictive effect of four imaging scoring systems on the unfavorable prognosis in the patients with acute basilar artery occlusion (BAO) after endovascular thrombectomy. Methods From March 2012 to August 2018, a total of 57 patients with acute BAO were treated with endovascular thrombectomy, preoperative DWI Posterior Circulation Alberta Stroke Program Early CT Score (pc ⁃ ASPECTS), DWI Brain Stem Score (BSS), Posterior Circulation CTA (pc ⁃ CTA) and Basilar Artery CTA (BATMAN) were used. Thrombolysis in Cerebral Infarction (TICI) was used to evaluate the incidence of vascular recanalization. The incidence of symptomatic intracranial hemorrhage (sICH) was recorded within 36 h. The prognosis was evaluated by modified Rankin Scale (mRS) at 3 months. Univariate and multivariate backward Logistic regression analysis were used to screen the risk factors related to the unfavoriable prognosis in the patients with acute BAO after endovascular thrombectomy. Receiver operating characteristic curve (ROC) was used to calculate the area under the curve (AUC), and evaluate the predictive value of DWI pc ⁃ ASPECTS, DWI BSS, pc ⁃ CTA and BATMAN scores for prognosis. Results In 57 patients, 53 patients (92.98% ) had successful recanalization, 2 (3.51%) had partial recanalization, 2 (3.51%) had no recanalization, 3 (5.26%) had sICH, 22 (38.60%) had good prognosis, 35 (61.40%) had poor prognosis, and 14 (24.56%) died. After univariate and multivariate backward Logistic regression analysis, higher NIHSS score on admission ( OR = 0.879, 95% CI: 0.783-0.986; P = 0.028), higher DWI BSS score ( OR = 0.348, 95% CI: 0.177-0.683; P = 0.002) and lower BATMAN score ( OR = 1.549, 95% CI: 1.019-2.353; P = 0.040) were risk factors for unfavorable prognosis of patients with acute BAO after endovascular thrombectomy. ROC analysis of the four radiographic scoring systems showed that the AUC of DWI pc ⁃ ASPECTS, DWI BSS, pc ⁃ CTA and BATMAN score were 0.787 (95% CI: 0.658-0.884, P = 0.000), 0.861 (95% CI: 0.744-0.938, P = 0.000), 0.634 (95% CI: 0.496-0.757, P = 0.091) and 0.698 (95% CI: 0.562-0.813, P = 0.012), respectively. Conclusions Higher NIHSS score on admission, higher DWI BSS score and lower BATMAN score are risk factors for unfavorable prognosis of acute BAO treated with endovascular thrombectomy. DOI：10.3969/j.issn.1672⁃6731.2020.05.006