Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy

Xi Zhong; Xu Tong; Xuan Sun; Feng Gao; Dapeng Mo; Yilong Wang; Zhongrong Miao

doi:10.3389/fneur.2020.592003

Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy

Front Neurol. 2020 Nov 19:11:592003. doi: 10.3389/fneur.2020.592003. eCollection 2020.

Authors

Xi Zhong^{1

2}, Xu Tong^{3

4}, Xuan Sun³, Feng Gao³, Dapeng Mo³, Yilong Wang^{1

5

6}, Zhongrong Miao²

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Neurology, Peking University Shougang Hospital, Beijing, China.
³ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, China.
⁵ China National Clinical Research Center for Neurological Diseases, Beijing, China.
⁶ Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.

Abstract

Background: We aim to identify the risk factors of early neurological deterioration (END) despite successful recanalization and explore the association of END with 90-day outcomes in acute basilar artery occlusion (BAO) treated by endovascular therapy (EVT). Methods: A prospectively registered consecutive cohort of BAO patients with successful recanalization by EVT in a tertiary stroke center during a 6-year period was reviewed. END was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase ≥4 points, or death, from baseline to 24 h after EVT. Multivariate logistic regression analysis was used to identify the risk factors of END. The 90-day outcomes between END and non-END groups were compared by Pearson's χ² test. Results: END was observed in 21 of 148 patients included in this study. Multivariate logistic regression analysis showed that patients with progressive or fluctuating symptoms had a higher risk of END than those with symptoms of acute attack (OR 5.52, 95% CI 1.73-17.63), and NIHSS score and puncture-to-recanalization time (PTR), as continuous variables, were also significantly associated with END. Using a generalized additive model with spline smoothing function, we observed a linear relationship between PTR (increased by 1 h) and END (OR 2.57, 95% CI 1.45-4.57), and a non-linear relationship between NIHSS score and END. Only when the NIHSS score was ≥23 points was it related to END (OR 0.7, 95% CI 0.6-0.9). In addition, patients with END had a lower proportion of 90-day favorable outcome (19.0 vs. 59.1%, p < 0.01) and higher mortality (33.3 vs. 13.4%, p = 0.048) than those with non-END. Conclusion: Mode of stroke onset, NIHSS score, and PTR may help to identify BAO patients with a higher risk of END after EVT. Moreover, END may affect the 90-day outcomes of these patients.

Keywords: acute stroke; basilar artery; endovascular treatment; prognostic factor; revascularization.