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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Basilar artery occlusion (BAO) led to death or disability in 80% of the patients in a previous study. The acute treatment for BAO patients includes intravenous thrombolysis and intra-arterial thrombectomy (IAT), but not all patients benefit from these treatments.
Research motivation
To date, large-scale studies on the clinical characteristic and predictors of BAO patients are still lacking.
Research objectives
To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.
Research 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 those that fulfilled the criteria defined in the Basilar Artery International Cooperation Study were included. The patients’ characteristics and factors related to outcome at 90 d were analyzed.
Research results
We identified 99 patients as real BAO cases. Among these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0–3). Moreover, 72 patients received IAT, while 13 patients received intravenous tissue-type plasminogen activator treatment. We found that initial National Institutes of Health Stroke Scale (NIHSS) and several BAO symptoms including impaired consciousness, tetraparesis, and pupillary abnormalities were significantly associated with an unfavorable outcome (P < 0.05). In the receiver operating characteristic (ROC) analysis, initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.
Research conclusions
Initial NIHSS score is the most important predictor of an unfavorable outcome in patients with BAO.
Research perspectives
Further large, prospective clinical studies of the outcome predictors of BAO are needed.
