Predicting outcomes after acute reperfusion therapy for basilar artery occlusion

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Jadhav , A P , Desai , S M , Panczykowski , D M , Rangaraju , S , Campbell , D , Ritvonen , J K , Schreiner , M , Silvennoinen , H , Gerber , J , Puetz , V , Raza , S A , Haussen , D C , Nogueira , R G , Strbian , D , Jovin , T G & Lindsberg , P J 2020 , ' Predicting outcomes after acute reperfusion therapy for basilar artery occlusion ' , European Journal of Neurology , vol. 27 , no. 11 , pp. 2176-2184 . https://doi.org/10.1111/ene.14406

Title: Predicting outcomes after acute reperfusion therapy for basilar artery occlusion
Author: Jadhav, A. P.; Desai, S. M.; Panczykowski, D. M.; Rangaraju, S.; Campbell, D.; Ritvonen, J. K.; Schreiner, M.; Silvennoinen, H.; Gerber, J.; Puetz, Volker; Raza, S. A.; Haussen, D. C.; Nogueira, R. G.; Strbian, D.; Jovin, T. G.; Lindsberg, P. J.
Contributor organization: Neurologian yksikkö
Department of Neurosciences
HUS Neurocenter
Helsinki University Hospital Area
HUS Medical Imaging Center
Department of Diagnostics and Therapeutics
University of Helsinki
Clinicum
Date: 2020-11
Language: eng
Number of pages: 9
Belongs to series: European Journal of Neurology
ISSN: 1351-5101
DOI: https://doi.org/10.1111/ene.14406
URI: http://hdl.handle.net/10138/333733
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 x 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.
Subject: acute stroke
CT
diffusion-weighted imaging
MRI
stroke recovery
thrombolysis
transient ischaemic attack
ENDOVASCULAR THERAPY
INTRAARTERIAL
STROKE
HYPOATTENUATION
THROMBECTOMY
CURVE
3112 Neurosciences
3124 Neurology and psychiatry
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion


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