Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3677
Peer-review started: August 10, 2021
First decision: October 20, 2021
Revised: November 1, 2021
Accepted: March 14, 2022
Article in press: March 14, 2022
Published online: April 26, 2022
Processing time: 254 Days and 10.2 Hours
In a previous study, basilar artery occlusion (BAO) was shown to lead to death or disability in 80% of the patients. The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy, but not all patients benefit from these treatments. Thus, understanding the predictors of outcome before initiating these treatments is of special interest.
To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.
We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019. We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke. A neurologist reviewed every case, and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included. We then analyzed the patients’ characteristics and factors related to the 90-d outcome.
We identified a total of 99 patients as real BAO cases. Of these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0–3). Moreover, 72 patients received intra-arterial thrombectomy, while 13 patients received intravenous tissue-type plasminogen activator treatment. We observed a favorable outcome in 33.3% of the cases and an unfavorable outcome in 66.7% of the cases. We found that the initial National Institutes of Health Stroke Scale (NIHSS) score and several BAO symptoms, including impaired consciousness, tetraparesis, and pupillary abnormalities, were significantly associated with an unfavorable outcome (P < 0.05), while cerebellar symptoms were associated with a favorable outcome (P < 0.05). In the receiver operating characteristic (ROC) analysis, the areas under the ROC curve of initial NIHSS score, impaired consciousness, tetraparesis, cerebellar symptoms, and pupillary abnormalities were 0.836, 0.644, 0.727, 0.614, and 0.614, respectively. Initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.
The most important predictor of an unfavorable outcome was the initial NIHSS score. BAO symptoms, including tetraparesis, impaired consciousness, and pupillary abnormality were also related to an unfavorable outcome.
Core Tip: In the emergency department, basilar artery occlusion (BAO) stroke is always severe, devastating, and difficult to diagnose. And it is more difficult to determine the further treatment, thrombectomy or not? We perform a retrospective study to investigate the outcome predictors of BAO. Our study showed that initial National Institutes of Health Stroke Scale (NIHSS) was the strongest predictor to the 90 d functional outcome. And we found a best cut-off value of NIHSS 30. That is, the score higher than 30 always relate to poor outcome, even received thrombectomy. We suggest that BAO patients with NIHSS higher than 30 may not benefit from thrombectomy treatment.