Factors influencing early neurological improvement after mechanical thrombectomy among patients with acute basilar artery occlusion: a single center prospective observational cohort study

Abstract

The predictive value of and the influencing factors associated with early neurological improvement (ENI) among patients with acute basilar artery occlusion (BAO) have not been well studied. The present study aimed to evaluate whether ENI predicted a better functional outcome and to identify the influencing factors of ENI. We performed a prospective observational analysis among 187 patients with acute BAO who underwent endovascular treatment (EVT) in Beijing Tiantan Hospital from January 2012 to July 2018. ENI was defined as having a drop on the National Institutes of Health Stroke Scale (NIHSS) by 8 or more scores or having a NIHSS of 0–1 within 24 h after EVT. A multivariate logistic regression model with backward selection was used to identify the influencing factors associated with ENI. ENI had a sensitivity of 0.69 and a specificity of 0.68 to predict a favorable outcome at 90 days after EVT. In addition, patients with ENIs had lower modified Rankin Scale score (mRS) (median: 2.0 vs. 5.0, p < 0.001) and were more likely to survive (95.2% vs. 72.0%, p < 0.001) and achieve functional independence (74.2% vs. 36.8%, p < 0.001). NIHSS before EVT, complete recanalization, white blood cell counts and general anesthetics were significant factors associated with ENI. A one-unit higher NIHSS and complete recanalization were associated with 1.04 (95% CI 1.01–1.08) and 2.71 (95% CI 1.14–6.45) times higher odds of achieving ENI, respectively. In conclusion, in patients with acute BAO, ENI within 24 hours after EVT can predict favorable outcomes at 90 day. Patients with higher NIHSS, lower white blood cell counts before surgery, without general anesthetics and patients with complete recanalization were more likely to achieve ENIs.

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References

  1. 1.

    Rangaraju S, Jovin TG, Frankel M, Schonewille WJ, Algra A, Kappelle LJ, Nogueira RG, BASICS Study Group (2016) Neurologic examination at 24 to 48 hours predicts functional outcomes in basilar artery occlusion stroke. Stroke 47:2534–2540

    Article  Google Scholar 

  2. 2.

    Soize S, Fabre G, Gawlitza M, Serre I, Bakchine S, Manceau PF, Pierot L (2019) Can ENI after mechanical thrombectomy be used as a surrogate for final stroke outcome? J Neurointerv Surg 11:450–454

    Article  Google Scholar 

  3. 3.

    Rangaraju S, Frankel M, Jovin TG (2016) Prognostic value of the 24-hour neurological examination in anterior circulation ischemic stroke: a post hoc analysis of two randomized controlled stroke trials. Interv Neurol 4:120–129

    Article  Google Scholar 

  4. 4.

    Kang DH, Jung C, Yoon W, Kim SK, Baek BH, Kim JT, Park MS, Kim YW, Hwang YH, Kim YS, Kim BJ, Han MK, Bae HJ (2018) Endovascular thrombectomy for acute basilar artery occlusion: a multicenter retrospective observational study. J Am Heart Assoc 7:e009419

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Hu SY, Yi HJ, Lee DH, Hong JT, Sung JH, Lee SW (2017) Effectiveness and safety of mechanical thrombectomy with stent retrievers in basilar artery occlusion: comparison with anterior circulation occlusions. J Korean Neurosurg Soc 60:635–643

    Article  Google Scholar 

  6. 6.

    Simonsen CZ, Yoo AJ, Sørensen LH, Juul N, Johnsen SP, Andersen G, Rasmussen M (2018) Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol 75:470–477

    Article  Google Scholar 

  7. 7.

    Saposnik G, Di Legge S, Webster F, Hachinski V (2005) Predictors of major neurologic improvement after thrombolysis in acute stroke. Neurology 65:1169–1174

    Article  Google Scholar 

  8. 8.

    Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, Engelter ST, Tanne D, Muir KW, Molina CA, Thijs V, Audebert H, Pfefferkorn T, Szabo K, Lindsberg PJ, de Freitas G, Kappelle LJ, Algra A, BASICS study group (2009) Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 8:724–730

    Article  Google Scholar 

  9. 9.

    Huber T, Kleine JF, Kaesmacher J, Bette S, Poppert H, Zimmer C, Boeckh-Behrens T (2016) Blood leukocytes as prognostic parameter in stroke thrombectomy. Cerebrovasc Dis 42:32–40

    Article  Google Scholar 

  10. 10.

    Wu TH, Chien KL, Lin HJ, Hsu HC, Su TC, Chen MF, Lee YT (2013) Total white blood cell count or neutrophil count predict ischemic stroke events among adult Taiwanese: report from a community-based cohort study. BMC Neurol 13:7

    Article  Google Scholar 

  11. 11.

    Schönenberger S, Uhlmann L, Hacke W, Schieber S, Mundiyanapurath S, Purrucker JC, Nagel S, Klose C, Pfaff J, Bendszus M, Ringleb PA, Kieser M, Möhlenbruch MA, Bösel J (2016) Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA 316:1986–1996

    Article  Google Scholar 

  12. 12.

    Löwhagen Hendén P, Rentzos A, Karlsson JE, Rosengren L, Leiram B, Sundeman H, Dunker D, Schnabel K, Wikholm G, Hellström M, Ricksten SE (2017) General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the anstroke trial (anesthesia during stroke). Stroke 48:1601–1607

    Article  Google Scholar 

  13. 13.

    Zhang Y, Jia L, Fang F, Ma L, Cai B, Faramand A (2019) General anesthesia versus conscious sedation for intracranial mechanical thrombectomy: a systematic review and meta-analysis of randomized clinical trials. J Am Heart Assoc 8:e011754

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Campbell B, van Zwam WH, Goyal M, Menon BK, Dippel D, Demchuk AM, Bracard S, White P, Dávalos A, Majoie C, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos Y, Bang OY, Nogueira RG, Devlin TG, HERMES collaborators (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 17:47–53

    Article  Google Scholar 

  15. 15.

    Kharitonova TV, Melo TP, Andersen G, Egido JA, Castillo J, Wahlgren N, SITS investigators (2013) Importance of cerebral artery recanalization in patients with stroke with and without neurological improvement after intravenous thrombolysis. Stroke 44:2513–2518

    Article  Google Scholar 

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Funding

This work was supported by the National Key Research and Development Program of China (2016YFC1301501) and Beijing Municipal Science & Technology Commission (No. Z18110000171837). All the authors disclosed no financial relationships relevant to this study.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XS, HZ and XT. The first draft of the manuscript was written by XS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Zhongrong Miao.

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The authors declare that they have no conflict of interests.

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Approval was obtained from the ethics committee of Beijing Tiantan Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data.

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Sun, X., Zhang, H., Tong, X. et al. Factors influencing early neurological improvement after mechanical thrombectomy among patients with acute basilar artery occlusion: a single center prospective observational cohort study. J Thromb Thrombolysis 51, 180–186 (2021). https://doi.org/10.1007/s11239-020-02153-0

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Keywords

  • Cerebrovascular disorders
  • Thrombectomy
  • Stroke
  • Neurological improvement