AccScience Publishing / AN / Volume 2 / Issue 4 / DOI: 10.36922/an.1641
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ORIGINAL RESEARCH ARTICLE

Predicting futile recanalization risk in acute basilar artery occlusion: Combination of collateral status and pre-procedural systemic inflammation response index

Yao-Wu Liu1† ,  Bo Du1,2,3† ,  Bilal Muhammad2 ,  Qi-Yang Yuan1 ,  Shuo Li1 ,  Jin-Jin Yang1 ,  Yan-Bo Cheng1,2 ,  Shi-Guang Zhu1,2 ,  Dian-Shuai Gao1,3* ,  De-Qin Geng1,2,3*
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1 Department of Neurology, Faculty of First Clinical Medical, Xuzhou Medical University, Xuzhou, Jiangsu Province, China
2 Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
3 Department of Neurology, Faculty of Xuzhou Medical University, Nanjing Medical University, Nanjing, Jiangsu Province, China
Advanced Neurology 2023, 2(4), 1641 https://doi.org/10.36922/an.1641
Submitted: 20 August 2023 | Accepted: 28 November 2023 | Published: 12 December 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Acute basilar artery occlusion (ABAO) is a rare form of acute ischemic stroke (AIS). Endovascular treatment (EVT) has emerged as a primary therapeutic approach for achieving early reperfusion of the ischemic area. However, a favorable prognosis remains elusive for a considerable number of patient post-recanalization. The assessment of disparities in hematological and radiological indicators is of notable significance for predicting the prognosis of AIS patients. Our study aimed to predict futile recanalization (FR) by analyzing inflammation levels and collateral status in ABAO patients treated with EVT. Clinical data were collected from January 2019 to March 2023. The angiographic collateral grading system for basilar artery occlusion (ACGS-BAO) and the systemic inflammation response index (SIRI) was employed to assess the collateral status and inflammation levels, respectively. FR was defined as patients experiencing an unfavorable functional outcome (modified Rankin Scale >2) at 3-month post-EVT, despite successful recanalization (modified Thrombolysis in Cerebral Infarction 2b or 3). Logistic regression models were utilized to analyze the association of ACGS-BAO and SIRI with FR. A total of 72 (65.5%) patients developed FR. Multivariate logistic analysis revealed that ACGS-BAO (odds ratio [OR]: 0.343, 95% confidence interval [CI]: 0.179 – 0.658, P = 0.001), procedure time (OR: 1.028, 95% CI: 1.007 – 1.050, P = 0.01), and natural logarithm-transformed of the SIRI (Ln[SIRI]) (OR: 2.857, 95% CI: 1.518 – 5.380, P = 0.001) were independently associated with FR. In receiver operating characteristic analysis, the area under the curve for ACGS-BAO combined SIRI was 0.789 (95% CI: 0.699 – 0.878; P < 0.001). The effects of ACGS-BAO and Ln(SIRI) on FR were similar in all subgroups (P > 0.10 for all interactions). In conclusion, poor collateral status and high inflammatory levels are independent predictors of FR after EVT in patients with ABAO.

Keywords
Futile recanalization
Collateral status
Inflammatory
Thrombectomy
Ischemic stroke
Funding
National Health Commission Brain Prevention Committee
References
  1. Israeli-korn SD, Schwammenthal Y, Yonash-Kimchi T, et al., 2010, Ischemic stroke due to acute basilar artery occlusion: proportion and outcomes. Isr Med Assoc J, 12: 671–675.

 

  1. Mattle HP, Arnold M, Lindsberg PJ, et al., 2011, Basilar artery occlusion. Lancet Neurol, 10: 1002–1014.

 

  1. Gory B, Eldesouky I, Sivan-Hoffmann R, et al., 2016, Outcomes of stent retriever thrombectomy in basilar artery occlusion: An observational study and systematic review. J Neurol Neurosurg Psychiatry, 87: 520–525. https://doi.org/10.1136/jnnp-2014-310250

 

  1. Zi W, Qiu Z, Wu D, et al., 2020, Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurol, 77: 561–573. https://doi.org/10.1001/jamaneurol.2020.0156

 

  1. Jovin TG, Li C, Wu L, et al., 2022, Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med, 387: 1373–1384. https://doi.org/10.1056/NEJMoa2207576

 

  1. Tao C, Nogueira RG, Zhu Y, et al., 2022, Trial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med, 387: 1361–1372. https://doi.org/10.1056/NEJMoa2206317

 

  1. Hussein HM, Georgiadis AL, Vazquez G, et al., 2010, Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke: A multicenter study. AJNR Am J Neuroradiol, 31: 454–458. https://doi.org/10.3174/ajnr.A2006

 

  1. Tomsick T, Broderick J, Carrozella J, et al., 2008, Revascularization results in the interventional management of stroke II trial. AJNR Am J Neuroradiol, 29: 582–587. https://doi.org/10.3174/ajnr.A0843

 

  1. Tateishi Y, Wisco D, Aoki J, et al., 2015, Large deep white matter lesions may predict futile recanalization in endovascular therapy for acute ischemic stroke. Interv Neurol, 3: 48–55. https://doi.org/10.1159/000369835

 

  1. Tomsick TA, Yeatts SD, Liebeskind DS, et al., 2015, Endovascular revascularization results in IMS III: Intracranial ICA and M1 occlusions. J Neurointerv Surg, 7: 795–802. https://doi.org/10.1136/neurintsurg-2014-011318

 

  1. Sun MS, Jin H, Sun X, et al., 2018, Free radical damage in ischemia-reperfusion injury: An obstacle in acute ischemic stroke after revascularization therapy. Oxid Med Cell Longev, 2018: 3804979. https://doi.org/10.1155/2018/3804979

 

  1. Nie X, Leng X, Miao Z, et al., 2023, Clinically ineffective reperfusion after endovascular therapy in acute ischemic stroke. Stroke, 54: 873–881. https://doi.org/10.1161/STROKEAHA.122.038466

 

  1. Iadecola C, Anrather J, 2011, The immunology of stroke: From mechanisms to translation. Nat Med, 17: 796–808. https://doi.org/10.1038/nm.2399

 

  1. Tariq N, Khatri R. 2008, Leptomeningeal collaterals in acute ischemic stroke. J Vasc Interv Neurol, 1: 91–95.

 

  1. Venema SM, Dankbaar JW, Van der Lugt A, et al., 2022, Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke. Stroke, 53: 3222–3234. https://doi.org/10.1161/STROKEAHA.121.037869

 

  1. Gao F, Tong X, Sun X, 2021, A new angiographic collateral grading system for acute basilar artery occlusion treated with endovascular therapy. Transl Stroke Res, 12: 559–568. https://doi.org/10.1007/s12975-020-00856-3

 

  1. Kayan Y, Meyers PM, Prestigiacomo CJ, et al., 2019, Current endovascular strategies for posterior circulation large vessel occlusion stroke: Report of the society of neurointerventional surgery standards and guidelines committee. J Neurointerv Surg, 11: 1055–1062. https://doi.org/10.1136/neurintsurg-2019-014873

 

  1. Voetsch B, DeWitt LD, Pessin MS, et al., 2004, Basilar artery occlusive disease in the New England medical center posterior circulation registry. Arch Neurol, 61: 496–504. https://doi.org/10.1001/archneur.61.4.496

 

  1. Nouh A, Remke J, Ruland S, 2014, Ischemic posterior circulation stroke: A review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol, 5: 30. https://doi.org/10.3389/fneur.2014.00030

 

  1. Liu X, Dai Q, Ye R, et al., 2020, Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): An open-label, randomised controlled trial. Lancet Neurol, 19: 115–122. https://doi.org/10.1016/S1474-4422(19)30395-3

 

  1. Langezaal L, Van der Hoeven E, Mont’Alverne F, et al., 2021, Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med, 384: 1910–1920. https://doi.org/10.1056/NEJMoa2030297

 

  1. Nappini S, Arba F, Pracucci G, et al., 2021, Bridging versus direct endovascular therapy in basilar artery occlusion. J Neurol Neurosurg Psychiatry, 92: 956–962. https://doi.org/10.1136/jnnp-2020-325328

 

  1. Nie X, Wang D, Pu Y, et al., 2022, Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion. Stroke Vasc Neurol, 7: 190–199. https://doi.org/10.1136/svn-2021-001242

 

  1. Ginsberg MD, 2018, The cerebral collateral circulation: Relevance to pathophysiology and treatment of stroke. Neuropharmacology, 134: 280–292. https://doi.org/10.1016/j.neuropharm.2017.08.003

 

  1. Bang OY, Saver JL, Kim SJ, et al., 2011, Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke, 42: 693–699. https://doi.org/10.1161/STROKEAHA.110.595256

 

  1. Van der Hoeven EJ, McVerry F, Vos JA, et al., 2016, Collateral flow predicts outcome after basilar artery occlusion: The posterior circulation collateral score. Int J Stroke, 11: 768–775. https://doi.org/10.1177/1747493016641951

 

  1. Da Ros V, Meschini A, Gandini R, et al., 2016, Proposal for a vascular computed tomography-based grading system in posterior circulation stroke: A single-center experience. J Stroke Cerebrovasc Dis, 25: 368–377. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.008

 

  1. Alemseged F, Shah DG, Diomedi M, et al., 2017, The basilar artery on computed tomography angiography prognostic score for basilar artery occlusion. Stroke, 48: 631–637. https://doi.org/10.1161/STROKEAHA.116.015492

 

  1. Puetz V, Sylaja PN, Coutts SB, et al., 2008, Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke, 39: 2485–2490. https://doi.org/10.1161/STROKEAHA.107.511162

 

  1. Parikh NS, Merkler AE, Iadecola C. Inflammation, autoimmunity, infection, and stroke: Epidemiology and lessons from therapeutic intervention. Stroke, 51: 711–718. https://doi.org/10.1161/STROKEAHA.119.024157

 

  1. De Meyer SF, Denorme F, Langhauser F, et al., 2016, Thromboinflammation in stroke brain damage. Stroke, 47: 1165–1172. https://doi.org/10.1161/STROKEAHA.115.011238

 

  1. Anrather J, Iadecola C, 2016, Inflammation and stroke: An overview. Neurotherapeutics, 3: 661–670. https://doi.org/10.1007/s13311-016-0483-x

 

  1. Justicia C, Panés J, Solé S, et al., 2003, Neutrophil infiltration increases matrix metalloproteinase-9 in the ischemic brain after occlusion/reperfusion of the middle cerebral artery in rats. J Cereb Blood Flow Metab, 23: 1430–1440. https://doi.org/10.1097/01.WCB.0000090680.07515.C8

 

  1. Amantea D, Nappi G, Bernardi G, et al., 2009, Post-ischemic brain damage: Pathophysiology and role of inflammatory mediators. FEBS J, 276: 13–26. https://doi.org/10.1111/j.1742-4658.2008.06766.x

 

  1. Prass K, Meisel C, Höflich C, et al., 2003, Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation. J Exp Med, 198: 725–736. https://doi.org/10.1084/jem.20021098

 

  1. Offner H, Vandenbark AA, Hurn PD, 2009, Effect of experimental stroke on peripheral immunity: CNS ischemia induces profound immunosuppression. Neuroscience, 158: 1098–1111. https://doi.org/10.1016/j.neuroscience.2008.05.033

 

  1. Gong P, Liu Y, Gong Y, et al., 2021, The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflammation, 18: 51. https://doi.org/10.1186/s12974-021-02090-6

 

  1. Yun S, Yi HJ, Lee DH, et al., 2021, Systemic inflammation response index and systemic immune-inflammation index for predicting the prognosis of patients with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis, 30: 105861. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105861

 

  1. Han K, Shi D, Yang L, et al., 2022, Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Ann Med, 54: 1667–1677. https://doi.org/10.1080/07853890.2022.2083671

 

  1. Sun L, Hu W, Liu M, et al., 2020, High systemic inflammation response index (SIRI) indicates poor outcome in gallbladder cancer patients with surgical resection: A single institution experience in China. Cancer Res Treat, 52: 1199–1210. https://doi.org/10.4143/crt.2020.303

 

  1. Zhang Y, Xing Z, Zhou K, et al., 2021, The predictive role of systemic inflammation response index (SIRI) in the prognosis of stroke patients. Clin Interv Aging, 16: 1997–2007. https://doi.org/10.2147/CIA.S339221

 

  1. Chu M, Luo Y, Wang D, et al., 2023, Systemic inflammation response index predicts 3-month outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis. Front Neurol, 14: 1095668. https://doi.org/10.3389/fneur.2023.1095668

 

  1. Yi HJ, Sung JH, Lee DH, 2021, Systemic inflammation response index and systemic immune-inflammation index are associated with clinical outcomes in patients treated with mechanical thrombectomy for large artery occlusion. World Neurosurg, 153: e282–e289. https://doi.org/10.1016/j.wneu.2021.06.113
Conflict of interest
The authors declare that they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Published by AccScience Publishing
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