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Advanced Neurology Futile recanalization of acute basilar artery occlusion

pre-operative alkaline phosphatase, cholinesterase, red deviation (SD) and compared using the independent
blood cell distribution width (RDW), platelet, neutrophil, sample t-test. For continuous variables lacking a normal
monocytes, and lymphocyte counts. Additionally, patient distribution, the median (25 – 75 interquartile range)
th
th
details were gathered based on the Trial of Org 10172 in Acute was reported, and comparisons were made using the
Stroke Treatment (TOAST) criteria, National Institutes of Mann–Whitney U-test. Categorical variables were
Health Stroke Scale (NIHSS), Posterior Circulation Acute expressed as counts and percentages (%) and compared
Stroke Prognosis Early Computed Tomography Score using the Chi-square test. To address skewed original
(pc-ASPECTS) derived from non-contrast computed values, natural logarithm-transformed values were applied
tomography, occlusion site, surgical modalities, onset- in the statistical analyses of SIRI. A multivariable logistic
to-groin puncture time (OPT), onset-to-recanalization regression model, controlling for potential confounders,
time (ORT), and intravenous thrombolysis (IVT). The was employed to determine adjusted odds ratios (OR) with
ACGS-BAO was utilized to assess collateral circulation, corresponding 95% confidence intervals (CI), assessing
employing four grades: Grade 1 defined as neither posterior ACGS-BAO and natural logarithm-transformed of the SIRI
communicating artery (PComA) nor leptomeningeal (Ln[SIRI]) as independent predictors of FR. Confounders
collaterals were present, without filling to the top of the were defined as baseline variables exhibiting a difference
basilar artery (BA); grade 2 defined as the presence of at a level of P < 0.05 in univariable analysis. Receiver
either PComA or leptomeningeal collaterals but without operating characteristic (ROC) curves were generated
filling to the top of BA; grade 3 defined as the presence to calculate sensitivity and specificity, determining the
of either PComA or leptomeningeal collaterals, with cutoff value. At the same time, DeLong’s test was utilized
partial filling to the top of BA; and grade 4 defined as the for pairwise comparison of the ROC between SIRI,
presence of either PComA or leptomeningeal collaterals, ACGS-BAO, and their combination. The predictive power
with complete filling to the top of BA. Poor collateral of ACGS-BAO and Ln(SIRI) for FR was explored across
status, based on ACGS-BAO, is defined as a grade of 1–2, different subgroups defined by sex (male and female), age
intermediate status as grade 3, and good status as grade 4. (≤60 years and >60 years), OPT (≤6 h and >6 h), stroke
In addition, SIRI was calculated as follows: severity (NIHSS ≤20 and >20), and etiology (in situ stenosis
Neutrophil count and embolism). All tests were two-tailed, and statistical
Monocyte count× (I) significance was defined as P < 0.05.
Lymphocyte count
3. Results
The SIRI value was determined using hemogram
parameters measured preprocedurally. 3.1. Clinical characteristics of patients at baseline
Neuro-interventional experts, independent of this In this study, we collected data from 127 patients with
study, evaluated relevant imaging data. Patient follow- ABAO, and among them, 11 patients did not achieve
ups were conducted by trained professionals who were successful recanalization. Ultimately, our study included a
not aware of the details of this experimental study. These total of 110 patients with ABAO. The enrollment flow is
follow-ups occurred either over the telephone or in the illustrated in Figure 1.
clinic, involving the patient or their family. The mean age of the participants was 63.35 ± 12.10 years,

2.4. Outcome assessment with 78 (70.9%) of them being men. Common
comorbidities observed among the patients included
The mRS score was employed to assess neurologic hypertension (66 [60%]), diabetes mellitus (34 [62.1%]),
functional outcomes at the 3-month mark. This scale spans coronary heart disease (19 [17.3%]), atrial fibrillation
from 0 (no residual stroke symptoms) to 6 (death). The (34 [30.9%]), and prior stroke (40 [36.4%]). Further details
primary outcome of this study pertained to FR subsequent on baseline characteristics are summarized in Table 1.
to EVT. FR was defined as an mRS rating falling within
the range of 3 – 6 at the 3-month assessment, even in cases During the follow-up period, 72 patients (65.45%)
where successful recanalization had been achieved. exhibited a 90-day mRS score from 3 to 6 points, indicating
FR and 34 patients (30.90%) succumbed to the condition.
2.5. Statistical analysis Comparisons between the FR and non-FR groups
Patients were divided into two groups based on the revealed significant differences in various parameters.
occurrence of FR. The normality of variables was assessed Specifically, the FR group scored higher systemic immune
using the Shapiro–Wilk test. Continuous variables with a inflammation index (SII) (1589.82 [794.72 – 2515.65])
normal distribution were expressed as mean ± standard vs. 771.30 [399.17 – 1518.11], P = 0.001) and SIRI

Volume 2 Issue 4 (2023) 3 https://doi.org/10.36922/an.1641