Background and Purpose:Basilar artery occlusion (BAO) is associated with a high risk of disability and mortality. The objective of this study was to investigate prognostic factors in patients with acute basilar artery occlusion treated with mechanical thrombectomy, focusing on collateral status and recanalization time from symptom onset.Methods:Eligible patients from January 2012 to October 2019 who underwent endovascular treatment due to acute BAO were reviewed. The baseline posterior circulation collateral status was assessed with the basilar artery on computed tomography angiography score and posterior circulation collateral score. Good outcomes were defined as a modified Rankin Scale score of ≤2 at 3 months and successful recanalization as Thrombolysis in Cerebral Infarction grades 2b, 3. The associations between baseline and clinical parameters and favorable outcomes were evaluated with logistic regression.Results:Our sample included a total of 81 eligible patients (49 males, mean age 70.3 years) with a median baseline and discharge National Institutes of Health Stroke Scale score of 12. Patients with good outcomes showed a lower baseline National Institutes of Health Stroke Scale score, a greater proportion of distal BAO, and a higher basilar artery on computed tomography angiography and posterior circulation collateral score (P<0.001). According to subgroup analysis of patients within and over 6 or 12 hours, the time from symptom onset to recanalization was not correlated with good outcomes. Multivariable logistic analysis showed baseline National Institutes of Health Stroke Scale <15 (odds ratio, 8.49 [95% CI, 2.01–35.82]; P=0.004), posterior circulation collateral score ≥6 (odds ratio, 3.79 [95% CI, 1.05–13.66]; P=0.042), and distal BAO (odds ratio, 3.67 [95% CI, 1.10–12.26]; P=0.035) were independent predictors of good outcomes.Conclusions:This study suggested that good collateral circulation and distal BAO are independent predictors of clinical outcome after endovascular treatment in patients with acute BAO. In particular, patients with good initial collateral status and distal BAO may consider endovascular treatment even if the treatment is started beyond the standard time limits.

中文翻译：

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机械性血栓切除术治疗基底动脉阻塞：与后循环侧支评分相关的临床结果。

背景与目的：基底动脉闭塞（BAO）与残疾和死亡的高风险有关。这项研究的目的是研究机械性血栓切除术治疗急性基底动脉阻塞的患者的预后因素，重点是从症状发作开始的侧支状态和再通时间。方法：2012年1月至2019年10月因急性接受血管内治疗的合格患者对BAO进行了审查。使用计算机断层扫描血管造影评分和后循环旁支评分，通过基底动脉评估基线后循环旁支状态。良好的预后被定义为在3个月时改良的Rankin量表评分≤2，并且在脑梗死2b，3级中成功地再次通融为溶栓。P <0.001）。根据6或12个小时内和超过6个小时内患者的亚组分析，从症状发作到再次通气的时间与良好的预后无关。多变量逻辑分析显示，美国国立卫生研究院卒中量表的基线<15（比值比，8.49 [95％CI，2.01–35.82]；P = 0.004），后循环侧支评分≥6（比值比，3.79 [95％CI，1.05] –13.66]；P = 0.042）和远端BAO（赔率，3.67 [95％CI，1.10-12.26]；P= 0.035）是良好预后的独立预测因子。结论：这项研究表明，良好的侧支循环和远端BAO是急性BAO血管内治疗后临床预后的独立预测因子。特别是，具有良好初始侧支状态和远端BAO的患者，即使开始治疗超出标准时间限制，也可以考虑进行血管内治疗。