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Predicting outcomes after acute reperfusion therapy for basilar artery occlusion.

Abstract：

BACKGROUND AND PURPOSE:Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision-making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO. METHODS:This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the USA and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day modified Rankin scale scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-Vertebrobasilar (POST-VB) score). The POST-VB score was evaluated and internally validated with regard to calibration and discriminatory ability. External validity was assessed in patient cohorts at three separate centers. RESULTS:In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure magnetic resonance imaging (P < 0.01) and younger age (P = 0.01). POST-VB score was calculated as: age + (10 × brainstem infarct volume). POST-VB score demonstrated excellent discriminatory ability [area under the receiver-operating characteristic curve (AUC) = 0.91] and adequate calibration (P = 0.88) in the derivation cohort (Center A). It performed equally well across the three external validation cohorts (Center B, AUC = 0.89; Center C, AUC = 0.78; Center D, AUC = 0.80). Overall, a POST-VB score < 49 was associated with an 88% likelihood of favorable outcome, as compared to 4% with a score ≥ 125. CONCLUSIONS:The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.

journal_name

Eur J Neurol

journal_title

European journal of neurology

authors

Jadhav AP,Desai SM,Panczykowski DM,Rangaraju S,Campbell D,Ritvonen JK,Schreiner M,Silvennoinen H,Gerber J,Puetz V,Raza SA,Haussen DC,Nogueira RG,Strbian D,Jovin TG,Lindsberg PJ

doi

10.1111/ene.14406

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

2176-2184

issue

eissn

1351-5101

issn

1468-1331

journal_volume

pub_type

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Predicting outcomes after acute reperfusion therapy for basilar artery occlusion.