Xuelei Zhang1,2,3,4, Gang Luo1,2,3,4, Dapeng Mo1,2,3,4, Ning Ma1,2,3,4, Feng Gao1,2,3,4, Jingyu Zhang1,2,3,4, Zhongrong Miao5,6,7,8. 1. Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. 2. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. 3. China National Clinical Research Center for Neurological Diseases Center of Stroke, Beijing, China. 4. Beijing Institute for Brain Disorders, Beijing, China. 5. Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. zhongrongm@163.com. 6. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. zhongrongm@163.com. 7. China National Clinical Research Center for Neurological Diseases Center of Stroke, Beijing, China. zhongrongm@163.com. 8. Beijing Institute for Brain Disorders, Beijing, China. zhongrongm@163.com.
Abstract
PURPOSE: To investigate the predictors for good outcome of endovascular therapy (EVT) for patients with acute vertebrobasilar artery occlusion (VBAO) due to intracranial atherosclerosis stenosis (ICAS). METHODS: From April 2012 to February 2018, patients with VBAO due to ICAS who received EVT were retrospectively analyzed. ICAS was defined as fixed stenosis of >70%, or a degree of fixed stenosis >50% in addition to either perfusion impairment or evidence to re-occlusion. Good outcome was defined as mRS≤2 at 90 days. Both logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the predictors. RESULTS: Among 103 patients enrolled in the analysis, 40.8% achieved good outcome. Prior antiplatelet therapy (OR, 7.301; 95% CI, 1.761-30.265; P=0.006), EVT+IVT (OR, 7.343; 95% CI, 1.621-33.263; P=0.010 ), the pc-ASPECT on DWI (OR, 1.705; 95% CI, 1.127-2.580; P=0.012), BATMAN (OR, 1.395; 95% CI, 1.005-1.937; P=0047), general anesthesia (OR, 0.081; 95% CI, 0.010-0.633; P=0.017), onset-to-recanalization time (≤542min vs. >542min) (OR, 0.194; 95% CI, 0.057-0.661; P=0.009) and the initial NIHSS (OR, 0.882; 95% CI, 0.820-0.949; P=0.001) were significantly associated with good outcome in logistic regression. Based on ROC analyses, initial NIHSS score (area under the curve [AUC]= 0.816, p <0.001; cutoff,19.5; sensitivity, 78.7%; specificity, 72.5%) was significant predictors of good outcome. CONCLUSIONS: For patients with VBAO due to ICAS, prior antiplatelet therapy, EVT+IVT, local anesthesia, short onset-to-recanalization time, a low initial NIHSS, a high pc-ASPECT and BATMAN might be helpful to predict the good outcome at 90 days after EVT.
PURPOSE: To investigate the predictors for good outcome of endovascular therapy (EVT) for patients with acute vertebrobasilar artery occlusion (VBAO) due to intracranial atherosclerosis stenosis (ICAS). METHODS: From April 2012 to February 2018, patients with VBAO due to ICAS who received EVT were retrospectively analyzed. ICAS was defined as fixed stenosis of >70%, or a degree of fixed stenosis >50% in addition to either perfusion impairment or evidence to re-occlusion. Good outcome was defined as mRS≤2 at 90 days. Both logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the predictors. RESULTS: Among 103 patients enrolled in the analysis, 40.8% achieved good outcome. Prior antiplatelet therapy (OR, 7.301; 95% CI, 1.761-30.265; P=0.006), EVT+IVT (OR, 7.343; 95% CI, 1.621-33.263; P=0.010 ), the pc-ASPECT on DWI (OR, 1.705; 95% CI, 1.127-2.580; P=0.012), BATMAN (OR, 1.395; 95% CI, 1.005-1.937; P=0047), general anesthesia (OR, 0.081; 95% CI, 0.010-0.633; P=0.017), onset-to-recanalization time (≤542min vs. >542min) (OR, 0.194; 95% CI, 0.057-0.661; P=0.009) and the initial NIHSS (OR, 0.882; 95% CI, 0.820-0.949; P=0.001) were significantly associated with good outcome in logistic regression. Based on ROC analyses, initial NIHSS score (area under the curve [AUC]= 0.816, p <0.001; cutoff,19.5; sensitivity, 78.7%; specificity, 72.5%) was significant predictors of good outcome. CONCLUSIONS: For patients with VBAO due to ICAS, prior antiplatelet therapy, EVT+IVT, local anesthesia, short onset-to-recanalization time, a low initial NIHSS, a high pc-ASPECT and BATMAN might be helpful to predict the good outcome at 90 days after EVT.
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