Predicting Outcome after Endovascular Reperfusion Therapy for Acute Basilar Occlusion in Patients with Pretreatment DWI–ASPECTS (Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Score) ≤6

Abstract

Background and Purpose: The prognosis of patients with acute basilar arterial occlusion (BAO) after endovascular reperfusion therapy (ERT) with diffusion-weighted imaging (DWI)-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≤ 6 remains unclear. Aims: We aimed to assess the characteristics and prognosis of ERT in patients with acute BAO and DWI-pc-ASPECT ≤ 6. Methods: We analyzed data collected from January 1, 2012, to January 31, 2018, in a prospective neuro-interventional registry of consecutive patients treated with ERT. Clinical and imaging data patients with DWI-pc-ASPECT ≤ 6 who underwent ERT for acute BAO were collected for this study. A good clinical outcome (GCO) was defined as a modified Rankin Scale score ≤ 2 at 90 days. Results: Forty-five acute BAO patients with DWI-pc-ASPECT ≤6 were included. Among them, 11 (24.4%) patients had GCO at 90 days. Patients with GCO had mild neurologic symptoms at presentation [National Institutes of Health Stroke Scale (NIHSS) 19.0 (12.0–25.0) vs. 8.0 (6.0–11.5); P = 0.003] and were younger patients[72.5 (57.0–80.0) vs. 63.0 (55.5–69.0), P = 0.096] than those with poor clinical outcome (PCO). In a multivariate model, low initial NIHSS score (odds ratio, 1.21; 95% confidence interval, 1.07–1.44; P = 0.0093) and age over 70 years (odds ratio, 15.27; 95% confidence interval, 1.85–379.79; P = 0.0321) were independent predictors of PCO. Conclusions: Even with DWI-pc-ASPECT ≤ 6, GCO can be achieved after ERT. Mild initial symptoms and below the 70 years old can predict a better clinical outcome.