Nomogram model of functional outcome for endovascular treatment in patients with acute basilar artery occlusion

Lei Li; Jin Lv; Jian-Jia Han; Yuan Gao; Zhao-Xuan Yan; Qi Wu; Xiao-Li Zhang; Feng Gao

doi:10.3389/fneur.2023.1277189

Nomogram model of functional outcome for endovascular treatment in patients with acute basilar artery occlusion

Front Neurol. 2023 Oct 19:14:1277189. doi: 10.3389/fneur.2023.1277189. eCollection 2023.

Authors

Lei Li^#¹, Jin Lv^#², Jian-Jia Han^#¹, Yuan Gao¹, Zhao-Xuan Yan¹, Qi Wu¹, Xiao-Li Zhang^{1

3}, Feng Gao¹

Affiliations

¹ Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Radiotherapy, The PLA Rocket Force Characteristic Medical Center, Beijing, China.
³ China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Background and purpose: The efficacy and safety of endovascular treatment (EVT) in acute basilar artery occlusion (ABAO) has been confirmed by four randomized clinical trials. Nevertheless, the predictors of a 90-day favorable outcome after EVT have not been elucidated. We attempted to establish a nomogram for the prediction of a 90-day favorable outcome in ABAO patients with EVT.

Methods: Clinical data of ABAO patients with EVT were obtained from two nationwide clinical trial registries in China. Factors associated with a 90-day favorable outcome were screened by multivariable step-wise regression on the basis of univariable analysis. A nomogram was established to predict 90-day favorable outcome after EVT.

Results: The proportion of ABAO patients with a favorable outcome was 41.53% (157/378). Seven variables, including baseline National Institutes of Health Stroke Scale (NIHSS) <20 [odds ratio (OR): 8.330; P-value < 0.0001], posterior circulation Alberta Stroke Program Early CT (pc-ASPECT) score ≥7 (OR: 1.948; P-value = 0.0296), Pons-Midbrain Index (PMI) score < 2 (OR: 2.108; P-value = 0.0128), Posterior Circulation Collateral Score (PC-CS) ≥5 (OR: 3.288; P-value < 0.0001), local anesthesia (OR: 0.389; P-value = 0.0017), time from onset to recanalization (OTR) <330 min (OR: 2.594; P-value = 0.0013), and no occurrence of early neurological deterioration (END; OR: 0.039; P-value < 0.0001) were included into the nomogram, with C-index values of 0.8730 and 0.8857 in the training and the internal validation set, respectively.

Conclusions: The proposed nomogram provided a reliable prognostic scale, which can be employed in clinical settings for the selection and clinical management of ABAO patients.

Registration: https://www.clinicaltrials.gov, identifier: NCT03370939.

Keywords: acute basilar artery occlusion; endovascular treatment; favorable outcome; large vessel occlusion; nomogram.

Associated data

ClinicalTrials.gov/NCT03370939

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Beijing Natural Science Foundation (grant No. Z220016), and the National Natural Science Foundation of China (grant No. 62272325).