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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
Conflict of interest
The authors declare that they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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