Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3677-3685
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3677
Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients
Yu-Chen Chiu, Jia-Li Yang, Wei-Chun Wang, Hung-Yu Huang, Wei-Liang Chen, Pao-Sheng Yen, Ying-Lin Tseng, Hsiu-Hsueh Chen, Sheng-Ta Tsai
Yu-Chen Chiu, Department of Neurology, An Nan Hospital, China Medical University, Tainan 709204, Taiwan
Yu-Chen Chiu, Wei-Chun Wang, Hung-Yu Huang, Sheng-Ta Tsai, College of Medicine, China Medical University, Taichung 404332, Taiwan
Jia-Li Yang, Department of Anesthesiology, China Medical University Hospital, Taichung 404332, Taiwan
Wei-Chun Wang, Hung-Yu Huang, Sheng-Ta Tsai, Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan
Wei-Liang Chen, Ying-Lin Tseng, Department of Radiology, China Medical University Hospital, Taichung 404332, Taiwan
Pao-Sheng Yen, Department of Radiology, Kuang Tien General Hospital, Taichung 404332, Taiwan
Hsiu-Hsueh Chen, Stroke Center, China Medical University Hospital, Taichung 404332, Taiwan
Author contributions: Chiu YC contributed to the analysis and wrote the manuscript; Yang JL and Chen HH collected and analyzed the data; Wang WC revised the article; Huang HY designed the research; Chen WL, Yen PS, and Tseng YL provided substantial acquisition of data for the study; Tsai ST designed the research, wrote the manuscript, and supervised the report.
Supported by China Medical University Hospital, Taichung, Taiwan, No. DMR-111-103.
Institutional review board statement: This study secured ethical approval from the China Medical University Hospital, CMUH109-REC2-003.
Conflict-of-interest statement: The Authors declare that there is no conflict of interest.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author, STT.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Ta Tsai, MD, PhD, Attending Doctor, Doctor, Department of Neurology, China Medical University Hospital, No. 2 Yude Road, North District, Taichung 404332, Taiwan. tshengdar@gmail.com
Received: August 10, 2021
Peer-review started: August 10, 2021
First decision: October 20, 2021
Revised: November 1, 2021
Accepted: March 14, 2022
Article in press: March 14, 2022
Published online: April 26, 2022
Abstract
BACKGROUND

In a previous study, basilar artery occlusion (BAO) was shown to lead to death or disability in 80% of the patients. The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy, but not all patients benefit from these treatments. Thus, understanding the predictors of outcome before initiating these treatments is of special interest.

AIM

To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.

METHODS

We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019. We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke. A neurologist reviewed every case, and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included. We then analyzed the patients’ characteristics and factors related to the 90-d outcome.

RESULTS

We identified a total of 99 patients as real BAO cases. Of these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0–3). Moreover, 72 patients received intra-arterial thrombectomy, while 13 patients received intravenous tissue-type plasminogen activator treatment. We observed a favorable outcome in 33.3% of the cases and an unfavorable outcome in 66.7% of the cases. We found that the initial National Institutes of Health Stroke Scale (NIHSS) score and several BAO symptoms, including impaired consciousness, tetraparesis, and pupillary abnormalities, were significantly associated with an unfavorable outcome (P < 0.05), while cerebellar symptoms were associated with a favorable outcome (P < 0.05). In the receiver operating characteristic (ROC) analysis, the areas under the ROC curve of initial NIHSS score, impaired consciousness, tetraparesis, cerebellar symptoms, and pupillary abnormalities were 0.836, 0.644, 0.727, 0.614, and 0.614, respectively. Initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.

CONCLUSION

The most important predictor of an unfavorable outcome was the initial NIHSS score. BAO symptoms, including tetraparesis, impaired consciousness, and pupillary abnormality were also related to an unfavorable outcome.

Keywords: Basilar artery occlusion, National Institutes of Health Stroke Scale, Natural course, Outcome, Asian

Core Tip: In the emergency department, basilar artery occlusion (BAO) stroke is always severe, devastating, and difficult to diagnose. And it is more difficult to determine the further treatment, thrombectomy or not? We perform a retrospective study to investigate the outcome predictors of BAO. Our study showed that initial National Institutes of Health Stroke Scale (NIHSS) was the strongest predictor to the 90 d functional outcome. And we found a best cut-off value of NIHSS 30. That is, the score higher than 30 always relate to poor outcome, even received thrombectomy. We suggest that BAO patients with NIHSS higher than 30 may not benefit from thrombectomy treatment.