A New Angiographic Collateral Grading System for Acute Basilar Artery Occlusion Treated with Endovascular Therapy.

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.

journal_name

Transl Stroke Res

authors

Gao F,Tong X,Sun X,Miao Z

doi

10.1007/s12975-020-00856-3

subject

Has Abstract

pub_date

2020-09-28 00:00:00

eissn

1868-4483

issn

1868-601X

pii

10.1007/s12975-020-00856-3

pub_type

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