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Time-Dependent Endovascular Treatment Effect According to Collateral Status in Basilar Artery Occlusion
Jing Li1,2, Fengli Li3, Zhenguang Li1
1Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Huancui District, No. 70 Heping Road, Shandong Province, 264200, China.
Insights
Endovascular treatment (EVT) for basilar artery occlusion (BAO) shows better outcomes with good collateral circulation. Early EVT within 6 hours is crucial for poor collaterals, while longer windows exist for moderate to good collaterals.
Area of Science:
- Neurology
- Interventional Neurology
- Vascular Neurology
Background:
- Endovascular treatment (EVT) benefits for anterior circulation stroke are debated in patients with poor collaterals.
- Basilar artery occlusion (BAO) is a critical condition where collateral status may influence treatment efficacy.
- Understanding time-dependent EVT effects based on collateral status is essential for optimizing patient outcomes.
Purpose of the Study:
- To investigate the time-dependent effects of EVT on clinical outcomes in patients with BAO.
- To analyze the influence of posterior circulation collateral score (PC-CS) on the efficacy of EVT in BAO.
- To determine optimal treatment windows for EVT in BAO patients with varying collateral status.
Main Methods:
- Prospective, nationwide Chinese registry (BASILAR study) of 828 acute BAO patients.
- Comparison between standard medical therapy (SMT) alone and SMT plus EVT groups.
- Restricted cubic spline analyses (RCSA) to assess nonlinear relationships between EVT time and outcomes stratified by PC-CS.
Main Results:
- Good collateral circulation (PC-CS 6-10) was independently associated with improved outcomes with EVT (OR 1.899).
- In poor collaterals (PC-CS 0-3), favorable outcome probability decreased significantly within 6 hours post-EVT (to 10%).
- Moderate (PC-CS 4-5) and good collaterals maintained favorable outcome probabilities (approx. 30-40%) beyond 6 hours.
Conclusions:
- Good collateral status is a significant predictor of favorable outcomes in BAO patients undergoing EVT.
- Early EVT (within 6 hours) is recommended for BAO patients with poor collaterals.
- BAO patients with moderate to good collaterals may benefit from extended EVT time windows.
Abstract:
Prior studies on anterior circulation stroke have demonstrated that the benefits of endovascular treatment (EVT) may be absent in patients with poor collaterals. Our study focused on patients with basilar artery occlusion (BAO) to investigate time-dependent EVT effects according to the posterior circulation collateral score (PC-CS). The BASILAR study was a nationwide prospective Chinese registry of consecutive BAO patients. Patients were divided into groups receiving standard medical therapy alone (SMT group) or SMT plus EVT (EVT group). Restricted cubic spline analyses (RCSA) were performed to explore the nonlinear and linear relationships between EVT time and outcomes for different PC-CS. We included 828 patients with acute BAO. Compared with the poor collateral (PC-CS 0-3), the adjusted odds ratio of favorable outcome was 1.311 in patients with moderate (PC-CS 4-5) (95% CI, 0.781-2.201) and 1.899 with good (PC-CS 6-10) collateral (1.125-3.207) for EVT. RCSA revealed that in patients with PC-CS 0-3, the favorable outcome probability after EVT significantly decreased to 10% within 6 h and stabilized thereafter (Pnonlinearity = 0.035), while in patients with moderate and good collateral, the probability was maintained at approximately 30% and 40% respectively, even beyond 6 h (all Pnonlinearity > 0.05). Among patients with BAO, good collateral circulation was independently associated with improved outcomes along with the usage of thrombectomy. Patients with poor collaterals should receive EVT as early as possible, especially within 6 h of symptom onset, while the time window may be extended in patients with moderate and good collaterals. Unique identifier: ChiCTR1800014759.
