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Updated: Dec 7, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
A New Angiographic Collateral Grading System for Acute Basilar Artery Occlusion Treated with Endovascular Therapy
Feng Gao1, Xu Tong2, Xuan Sun2
1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. gaofengletter@sina.com.
Insights
A new grading system for collateral circulation in acute basilar artery occlusion (BAO) predicts patient outcomes after endovascular therapy (EVT). This tool, the ACGS-BAO, shows high reliability in forecasting functional independence and favorable outcomes.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Poor clinical outcomes are frequent in acute basilar artery occlusion (BAO) patients undergoing endovascular therapy (EVT).
- Predictive tools for functional outcomes in BAO after EVT are limited.
Purpose of the Study:
- To develop and validate a novel angiographic collateral grading system for acute BAO (ACGS-BAO).
- To assess the ACGS-BAO's ability to predict 90-day functional outcomes (independence, favorable outcome, death) in BAO patients treated with EVT.
Main Methods:
- A prospectively registered cohort of 173 acute BAO patients treated with EVT was reviewed.
- The ACGS-BAO system was developed, categorizing collateral status into poor (grades 1-2), intermediate (grade 3), and good (grade 4).
- Multivariable logistic regression and subgroup analyses evaluated the association of ACGS-BAO with 90-day outcomes; interobserver agreement was assessed using weighted kappa.
Main Results:
- The ACGS-BAO was independently associated with 90-day functional independence (OR=2.07) and favorable outcomes (OR=1.84).
- No significant association was found between ACGS-BAO and 90-day mortality (OR=0.78).
- The system demonstrated excellent interobserver reliability (weighted kappa=0.96) and consistent predictive performance across subgroups.
Conclusions:
- The ACGS-BAO is a reliable angiographic tool for predicting 90-day functional outcomes in acute BAO patients treated with EVT.
- Further validation in prospective multicenter studies is recommended before widespread clinical application.
Abstract:
Poor clinical outcomes despite endovascular therapy (EVT) are common in patients with acute basilar artery occlusion (BAO). We aimed to develop a new angiographic collateral grading system for predicting 90-day functional outcomes of acute BAO after EVT. A prospectively registered consecutive cohort of acute BAO patients treated with EVT in our center during a 6-year period was reviewed. The angiographic collateral grading system for BAO (ACGS-BAO) included 4 grades for poor (grade 1-2), intermediate (grade 3), and good (grade 4) collateral statuses. First, the independent association of ACGS-BAO with 90-day functional independence (mRS ≤ 2), favorable outcome (mRS ≤ 3), and death was evaluated by multivariable logistic regression model; then, the heterogeneity in the effects of ACGS-BAO on 90-day outcomes was explored among the subgroups stratified by age, time window, stroke severity, and etiology. Finally, the interobserver agreement of ACGS-BAO was assessed by weighted kappa statistic. Of 173 patients included in this study, 62 (35.8%), 83 (48.0%), and 36 (20.8%) achieved 90-day functional independence, favorable outcome, and death, respectively. Multivariable logistic analyses showed that ACGS-BAO was independently associated with functional independence (OR = 2.07, 95% CI = 1.05-4.07) and favorable outcome (OR = 1.84, 95% CI = 1.02-3.43) but not related to death (OR = 0.78, 95% CI = 0.37-1.64). Similar effects of ACGS-BAO on 90-day outcomes were seen across all subgroups (P > 0.10 for all interactions). The interobserver agreement of ACGS-BAO was very high (weighted kappa = 0.96, 95% CI = 0.93-0.99). The ACGS-BAO is an angiographic tool with excellent interobserver reliability that can be used to predict the 90-day outcome of acute BAO treated by EVT. Nevertheless, our findings are still needed to be confirmed in a prospective multicenter study before clinical application.
