Early venous filling is associated with unfavorable outcomes in acute basilar artery occlusion after mechanical thrombectomy.

Background

To investigate the association between early venous filling (EVF) on digital subtraction angiography and poor outcomes after mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO).

Methods

This retrospective, single-center cohort included consecutive patients with ABAO who underwent MT at a comprehensive stroke center, achieved successful recanalization (modified Thrombolysis in Cerebral Infarction grade ≥ 2b), and had 90-day functional follow-up data. Baseline clinical, imaging, and procedural variables were collected. Candidate predictors were assessed using univariable logistic regression. Four variables (fasting blood glucose, baseline National Institutes of Health Stroke Scale score, EVF, and posterior circulation Alberta Stroke Program Early CT score) were included in Firth penalized multivariable logistic regression models for postprocedural malignant cerebellar edema (MCE) and poor prognosis (90-day modified Rankin Scale score > 2). Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), with internal validation by bootstrap optimism correction using 1,000 resamples.

Results

Among 101 patients, 26 (25.7 %) had EVF, 29 (28.7 %) developed MCE, and 56 (55.4 %) had poor prognosis. With four predictors, the events-per-variable values were 7.25 for MCE and 11.25 for poor prognosis, using the smaller outcome category. EVF was associated with MCE (OR 34.650, 95 % CI 9.024-184.087; P < 0.001) and poor prognosis (OR 10.239, 95 % CI 2.889-54.718; P < 0.001) in the Firth models. For MCE, the apparent AUCs of the clinical model and the clinical model plus EVF were 0.804 and 0.944, respectively; the corresponding optimism-corrected AUCs were 0.788 and 0.926. For poor prognosis, the apparent AUCs were 0.762 and 0.836, and the optimism-corrected AUCs were 0.742 and 0.818. The optimism-corrected AUC increments with EVF were 0.138 for MCE and 0.076 for poor prognosis.

Conclusions

EVF was independently associated with MCE and poor prognosis after MT in patients with ABAO.