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Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion
Seungyon Koh1, Sung Eun Lee1,2, Woo Sang Jung3
1Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea.
Insights
Predictors of early neurological deterioration (END) in vertebrobasilar occlusion (VBO) stroke were identified. For endovascular therapy (EVT), distal basilar occlusion and reperfusion failure predicted END. For medical management (MM), higher SBP, shorter onset-to-door time, incomplete occlusions, and poor collaterals predicted END.
Area of Science:
- Neurology
- Vascular Neurology
- Stroke Medicine
Background:
- Vertebrobasilar occlusion (VBO) is a critical condition associated with a high risk of early neurological deterioration (END).
- Identifying predictors of END is crucial for optimizing treatment strategies in VBO patients.
- This study investigates factors contributing to END in both endovascular therapy (EVT) and medical management (MM) groups.
Purpose of the Study:
- To identify predictors of all-cause early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) undergoing primary endovascular therapy (EVT).
- To identify predictors of END due to ischemia progression (END-IP) in patients with VBO receiving medical management (MM).
Main Methods:
- Retrospective analysis of 174 patients diagnosed with VBO between 2010 and 2018.
- Comparative and multivariate analyses were employed to determine significant predictors.
- Specific analyses were conducted for the primary EVT group (N=66) and the MM group (N=108).
Main Results:
- In the EVT group, distal basilar occlusion (OR, 14.5) and reperfusion failure (eTICI < 2b, OR, 5.0) predicted all-cause END.
- In the MM group, higher systolic blood pressure (SBP) (per 10 mmHg, OR, 1.5), onset-to-door time <24 h (OR, 5.3), near-total occlusions (OR, 4.9), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6), and lower BATMAN collateral scores (OR, 1.6) predicted END-IP.
Conclusions:
- Predictors of END in VBO stroke differ between EVT and MM groups.
- Failure to achieve reperfusion and distal basilar occlusion are key factors for END in the EVT group.
- Higher SBP, shorter treatment delays, incomplete occlusions, larger infarct cores, and poorer collaterals are associated with END-IP in the MM group.
Abstract:
Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups. Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in the MM group. Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N = 66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.5 [95% confidence interval (CI), 1.4-154.4]) and reperfusion failure (eTICI < 2b67 (OR, 5.0 [95% CI, 1.3-19.9]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.5 [95% CI, 1.1-2.0]), stroke onset-to-door time <24 h (OR, 5.3 [95% CI, 1.1-2.0]), near-total occlusions (OR, 4.9 [95% CI, 1.2-19.6]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6 [95% CI, 1.0-2.5]), and lower BATMAN collateral scores (OR, 1.6 [95% CI, 1.1-2.2]) were predictive of END-IP. Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In the primary EVT group, failure to achieve reperfusion and distal basilar occlusion were associated with all-cause END. In the MM group, higher SBP at presentation, onset-to-door time less than 24 h, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.
