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Ischemic stroke
Original research
Endovascular treatment effect in vertebrobasilar artery occlusion patients with posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) <6
  1. Pan Zhang1,
  2. Zhixin Huang2,
  3. Yingjie Xu1,
  4. Wei Li3,
  5. Xianjun Huang4,
  6. Zhongkui Han5,
  7. Huanhuan Luan6,
  8. Yongkun Li7,
  9. Yong Yang8,
  10. Dengyue Zhai9,
  11. Miaomiao Hu1,
  12. Genpei Luo10,
  13. Wen Sun1
    1. 1Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
    2. 2Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
    3. 3Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
    4. 4Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
    5. 5Department of Neurology, Fuyang Tumour Hospital, Fuyang, Anhui, China
    6. 6Department of Neurology, The Fourth People's Hospital of Lu'an City, Lu' an City, China
    7. 7Department of Neurology, Fujian Provincial Hospital, Fuzhou, Fujian, China
    8. 8Department of Neurology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
    9. 9Department of Neurology, Hefei First People's Hospital, Hefei, Anhui, China
    10. 10Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
    1. Correspondence to Dr Wen Sun; sunwen_medneuro{at}163.com; Dr Genpei Luo; 13412332332{at}163.com

    Abstract

    Background Endovascular treatment (EVT) has revolutionized the standard treatment of vertebrobasilar artery occlusion (VBAO) with moderate infarct core, but its effectiveness in patients with a low posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) is unclear. This study aimed to assess EVT effects in VBAO patients with pc-ASPECTS <6.

    Methods This retrospective study enrolled patients with VBAO within 24 hours of the estimated occlusion time at 65 stroke centers in a nationwide registration in China. The primary outcome was a favorable shift in the modified Rankin Scale (mRS) at 90 days. The secondary outcomes included a favorable outcome (mRS 0–3) and functional independence (mRS 0–2). Propensity score matching and inverse probability of treatment weighting were used to compare the outcomes of patients treated with EVT and those with best medical management.

    Results A total of 431 patients with VBAO and pc-ASPECTS <6 were included. EVT was associated with a favorable shift in the mRS score at 90 days (OR 1.72, 95% CI 1.19 to 2.5), a higher probability of a favorable outcome (OR 1.66, 95% CI 1.02 to 2.74), and improved functional independence (OR 1.76, 95% CI 1.06 to 2.96). EVT also significantly reduced the risk of 90-day mortality (OR 0.62, 95% CI 0.40 to 0.96), but increased the risk of symptomatic intracranial hemorrhage (OR 2.76, 95% CI 1.06 to 8.58).

    Conclusion The results of this study suggest that EVT may be a safe and effective treatment option for patients with VBAO and pc-ASPECTS <6. Further studies are needed to investigate the effect of EVT in patients with pc-ASPECTS <6 and to identify patients who may benefit from EVT.

    • Thrombectomy
    • Stroke
    • Artery
    • Intervention

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2024-022115

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • PZ and ZH contributed equally.

      • Contributors WS, ZXH, GPL and PZ designed the study and initial analysis plan. WS, ZXH, YJX and PZ contributed to the statistical analysis, performed the data analysis, and wrote the draft of the manuscript. WS, YJX, PZ, GPL and MMH contributed to revision of the manuscript. All authors participated in the data collection, analysis, and interpretation. All authors critically reviewed this and subsequent drafts. All authors approved the final draft for submission. WS is the guarantor.

      • Funding The study was supported by Research Funds of Centre for Leading Medicine and Advanced Technologies of IHM No. 2023IHM01050.

      • 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.