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Advanced Neurology Futile recanalization of acute basilar artery occlusion

Table 2. Independent predictors of futile recanalization in ABAO patients
Variables Univariate logistic regression analysis Multivariate logistic regression analysis
β OR 95% CI P β OR 95% CI P
Ln (SII) 0.835 2.306 1.398 – 3.804 0.001
Ln (SIRI) 0.793 2.211 1.365 – 3.581 0.001 1.050 2.857 1.518 – 5.380 0.001
ALP 0.025 1.025 1.005 – 1.046 0.013
Intravenous rt-PA 1.256 3.511 1.218 – 10.116 0.020 2.194 8.974 2.315 – 34.788 0.002
NIHSS score 0.058 1.060 1.017 – 1.104 0.005
Procedure time 0.026 1.026 1.010 – 1.042 0.001 0.027 1.028 1.007 – 1.050 0.010
ACGS-BAO -1.048 0.350 0.206 – 0.597 <0.001 -1.070 0.343 0.179 – 0.658 0.001
HT 2.134 8.449 1.871 – 38.155 0.006
Surgical modalities
Intra-arterial thrombolysis Reference
Stent-retriever thrombectomy 1.634 5.125 1.910 – 13.750 0.001
aspiration thrombectomy 0.428 1.534 0.548 – 4.293 0.415
Abbreviations: ABAO: Acute basilar artery occlusion; ACGS-BAO: Angiographic Collateral Grading System for Basilar Artery Occlusion;
ALP: Alkaline phosphatase; HT: Hemorrhagic transformation; CI: Confidence interval; Ln (SII): Natural logarithm-transformed of systemic immune
inflammation index; Ln (SIRI): Natural logarithm-transformed of systemic inflammation response index; OR: Odds ratio; rt-PA: Recombinant tissue
plasminogen activator; NIHSS: National Institutes of Health Stroke Scale.

patients within 6 h of ABAO onset, the combination of IVT
and EVT (IVT + EVT) can potentially reduce mortality
rates . Coincidentally, another study demonstrated that,
[22]
compared to direct EVT, patients with ABAO who received
IVT+EVT treatment within 24 h of onset had better
functional outcomes at 90 days . However, in this study,
[23]
patients receiving EVT + IVT treatment exhibited a higher
rate of FR. We attribute this observation to the increased
rate of HT (26.7% vs. 21.3%) and a higher rate of severe
stroke (NIHSS > 20) (63.3% vs. 31.5%) in the IVT+EVT
group. Additionally, several patients were transferred to
our hospital after receiving intravenous thrombolysis at a
primary stroke center, implying a longer OPT. Therefore,
it is particularly important to choose a more appropriate
vascular recanalization method and predict FR in these
complex cases.
Few studies have delved into the mechanisms of FR.
Existing research suggests that reperfusion injury and
the “no-reflow” phenomenon are intricately linked to the
prognosis of acute cerebral infarction, with considerable
influence from the opening of collateral circulation and
Figure 2. Probability of FR according to ACGS-BAO and SIRI. inflammatory factors. This paper aims to investigate the
Abbreviations: ACGS-BAO: Angiographic Collateral Grading System prediction of FR from two aspects: Collateral circulation
for Basilar Artery Occlusion; FR: Futile recanalization; SIRI: Systemic status evaluation and inflammatory response level.
inflammation response index.
Collateral circulation serves as an auxiliary vascular
optimal treatment methods for ABAO. An ongoing structure that supplements cerebral blood flow in ischemic
debate surrounds the appropriateness of administering areas when the primary cerebral artery is severely narrowed
intravenous thrombolysis before EVT. The Italian Registry or occluded. The robustness of collateral circulation plays a
of EVT in Acute Stroke (IRETAS) study indicated that, for crucial role in identifying reperfusion, determining infarct

Volume 2 Issue 4 (2023) 6 https://doi.org/10.36922/an.1641