Predicting outcomes after acute reperfusion therapy for basilar artery occlusion

A P Jadhav; S M Desai; D M Panczykowski; S Rangaraju; D Campbell; J K Ritvonen; M Schreiner; H Silvennoinen; J Gerber; V Puetz; S A Raza; D C Haussen; R G Nogueira; D Strbian; T G Jovin; P J Lindsberg

doi:10.1111/ene.14406

Predicting outcomes after acute reperfusion therapy for basilar artery occlusion

Eur J Neurol. 2020 Nov;27(11):2176-2184. doi: 10.1111/ene.14406. Epub 2020 Jul 28.

Authors

A P Jadhav¹, S M Desai¹, D M Panczykowski¹, S Rangaraju², D Campbell², J K Ritvonen³, M Schreiner⁴, H Silvennoinen⁵, J Gerber⁶, V Puetz⁷, S A Raza², D C Haussen², R G Nogueira², D Strbian^{3

8}, T G Jovin⁹, P J Lindsberg^{3

8}

Affiliations

¹ Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
² Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA.
³ Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.
⁴ Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden, Germany.
⁵ Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁶ Institute of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany.
⁷ Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden Neurovascular Center, Dresden, Germany.
⁸ Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
⁹ Department of Neurology, Cooper University Hospital, Camden, NJ, USA.

PMID: 32558040
DOI: 10.1111/ene.14406

Abstract

Background and purpose: Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision-making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO.

Methods: This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the USA and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day modified Rankin scale scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-Vertebrobasilar (POST-VB) score). The POST-VB score was evaluated and internally validated with regard to calibration and discriminatory ability. External validity was assessed in patient cohorts at three separate centers.

Results: In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure magnetic resonance imaging (P < 0.01) and younger age (P = 0.01). POST-VB score was calculated as: age + (10 × brainstem infarct volume). POST-VB score demonstrated excellent discriminatory ability [area under the receiver-operating characteristic curve (AUC) = 0.91] and adequate calibration (P = 0.88) in the derivation cohort (Center A). It performed equally well across the three external validation cohorts (Center B, AUC = 0.89; Center C, AUC = 0.78; Center D, AUC = 0.80). Overall, a POST-VB score < 49 was associated with an 88% likelihood of favorable outcome, as compared to 4% with a score ≥ 125.

Conclusions: The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.

Keywords: CT; MRI; acute stroke; diffusion-weighted imaging; stroke recovery; thrombolysis; transient ischaemic attack.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Basilar Artery / diagnostic imaging
Endovascular Procedures*
Europe
Humans
Reperfusion
Retrospective Studies
Stroke*
Treatment Outcome
Vertebrobasilar Insufficiency*