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