Vascular Access Complexity and Thrombectomy Efficiency in Proximal MCA M1 Occlusion: Evaluation of the Bovine Aortic...

Background and Objectives: In this study, it was aimed to investigate the relationship between the Bovine Aortic Arch-Dolichoarteriopathy (B.A.D.) score and the procedural characteristics of mechanical thrombectomy, recanalization success, and 90-day functional outcomes in patients with acute ischemic stroke with proximal M1 occlusion of the middle cerebral artery (MCA). Materials and Methods: A total of 220 adult patients who underwent mechanical thrombectomy for proximal MCA M1 occlusion were included in this retrospective, single-center cohort study. The patients were divided into good B.A.D. (<2; n = 143) and poor B.A.D. (≥2; n = 77) groups. Admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT Score (ASPECTS) scores, collateral status, thrombectomy time intervals, number of passes, first-pass effect (FPE), and Modified Thrombolysis in Cerebral Infarction (mTICI) recanalization grades were evaluated. The primary outcome was functional independence at day 90 (mRS 0-2). Associations with procedural and clinical outcomes were evaluated using multivariable logistic and linear regression analyses. Results: The puncture-to-recanalization time was significantly longer in the poor B.A.D. group [67 (50.5-88.0) min vs. 43 (32.0-65.0) min, p < 0.001], and the FPE rate was lower (37.7% vs. 51.7%, p = 0.046). After adjustment for thrombectomy technique and clinical covariates, poor B.A.D. remained independently associated with lower odds of FPE success (aOR = 0.439, 95% CI: 0.229-0.839; p = 0.013). In the procedurally adjusted linear regression model, poor B.A.D. also remained independently associated with longer puncture-to-recanalization time after additional adjustment for the number of thrombectomy passes and thrombectomy technique (B = 0.294, 95% CI: 0.188-0.400; p < 0.001). Final mTICI ≥ 2b, ≥2c, and 3 recanalization rates did not differ between the groups. Although 90-day functional independence was lower in the poor B.A.D. group, the difference was not significant (51.9% vs. 63.6%, p = 0.092), and no statistically significant independent association between B.A.D. status and 90-day functional independence was observed in the multivariable analysis. Conclusions: Poor B.A.D. anatomy was associated with greater procedural complexity during mechanical thrombectomy for proximal MCA M1 occlusion, including longer puncture-to-recanalization time and lower odds of FPE success, even after adjustment for available procedural and clinical factors. However, no statistically significant independent association was demonstrated between B.A.D. status and 90-day functional independence, and final recanalization rates did not differ significantly between the groups. These findings suggest that the B.A.D. score may have potential value as a preprocedural marker of vascular access complexity; however, prospective external validation is required before its use for procedural planning can be recommended.