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  • Effect of the anastomosis between the posterior inferior cerebellar artery and the superior cerebellar artery on outcomes of acute basilar artery occlusion after endovascular treatment

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Ischemic stroke
Original research
Effect of the anastomosis between the posterior inferior cerebellar artery and the superior cerebellar artery on outcomes of acute basilar artery occlusion after endovascular treatment
  1. Jiacheng Huang1,2,
  2. Weilin Kong2,
  3. Jie Yang2,
  4. Maolin Wang3,
  5. Xianjun Huang4,
  6. Yan Wang5,
  7. Jun Luo6,
  8. Youlin Wu7,
  9. Guoyong Zeng8,
  10. Yue Wan9,
  11. Jiaxing Song2,
  12. Linyu Li2,
  13. Jinrong Hu2,
  14. Shuai Liu2,
  15. Weidong Luo2,
  16. Yan Tian2,
  17. Hongfei Sang2,
  18. Zhongming Qiu2,
  19. Fengli Li2,
  20. Wouter Schonewille10,
  21. Chang Liu1,
  22. Wenjie Zi1,2
  1. 1 Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
  2. 2 Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
  3. 3 Central Laboratory, Army Medical University Xinqiao Hospital, Chongqing, China
  4. 4 Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
  5. 5 Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, China
  6. 6 Department of Neurology, 404 Hospital, Mianyang, Sichuan, China
  7. 7 Department of Neurology, People's Hospital of Chongzhou, Chongzhou, China
  8. 8 Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
  9. 9 Department of Neurology, Yangluo District of Hubei Zhongshan Hospital, Wuhan, China
  10. 10 Department of Neurology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
  1. Correspondence to Dr Wenjie Zi, Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University; Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China; ziwenjie{at}126.com; Dr Chang Liu, Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; liuchangcdhy{at}yahoo.com

Abstract

Background The effects of secondary collateral compensation on outcomes remain unclear in patients with acute basilar artery occlusion (BAO) after endovascular treatment (EVT). This study aimed to evaluate the benefits of the anastomosis between the posterior inferior cerebellar artery (PICA) and the superior cerebellar artery (SCA) in BAO after EVT.

Methods This cohort study was conducted using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry. Patients with acute BAO and treated with EVT were included. The primary outcome was a modified Rankin Scale score of 0–2 at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (SICH) and 90-day mortality.

Results Of the 646 patients included in the study, 196 (30.3%) patients had a PICA–SCA anastomosis. The PICA–SCA anastomosis was significantly associated with independent functional outcome at 90 days (67/196 (34.2%) vs 109/450 (24.2%), adjusted OR (aOR) 1.80 (95% CI 1.13 to 2.86), p=0.01) and was significantly associated with a decreased rate of SICH (40/442 (9.0%) vs 5/193 (2.6%), aOR 0.29 (95% CI 0.11 to 0.76), p=0.01). No significant difference was found between PICA–SCA anastomosis and 90-day mortality (219/450 (48.7%) vs 80/196 (40.8%), aOR 0.72 (95% CI 0.48 to 1.08), p=0.11). Subgroup analysis showed that the association between independent functional outcome and PICA–SCA anastomosis was strongest in patients with middle BAO (27/77 (35.1%) vs 22/118 (18.6%), aOR 2.64 (95% CI 1.13 to 6.15), p=0.03).

Conclusions The PICA–SCA anastomosis is significantly associated with better functional outcomes in patients with acute BAO after EVT, especially in those with middle BAO.

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Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable requests.

https://doi.org/10.1136/jnis-2022-019409

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    Data availability statement

    Data are available upon reasonable request. Data are available from the corresponding author upon reasonable requests.

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    Footnotes

    • JH, WK, JY and MW contributed equally.

    • Contributors J-CH, W-LK, JY, M-LW were responsible for the study design, literature research, data acquisition, statistical analysis and manuscript drafting. X-JH, YW, JL, Y-LW, G-YZ, YW, J-XS, L-YL, J-RH, SL, W-DL, YT, H-FS, Z-MQ, F-LL were responsible for data acquisition. WS was responsible for the manuscript editing. W-JZ and CL were responsible for guaranteeing the integrity of the entire study, study design, literature research, statistical analysis, manuscript editing and final approval of this manuscript.

    • Funding This work was supported by the National Natural Science Foundation of China (No 82071323), Chongqing Natural Science Foundation (cstc2020jcyj-msxmX0926).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.