Tandem lesion was risk factor for endovascular treatment in acute basilar artery occlusion: a single center retrospective observational study

Abstract

Objective To evaluate whether patients with acute basilar artery occlusion (BAO) tandem lesion could affect the clinical outcome after receiving endovascular treatment (EVT) in a high ⁃ volume stroke center. Methods A total of 187 consecutive patients with acute BAO receiving EVT from January 2012 to July 2018 were recruited in this study. The patients were categorized into 2 groups with (25 cases) or without (162 cases) tandem lesion. Preoperative Posterior Circulation Alberta Stroke Program Early CT Score (pc ⁃ ASPECTS) and Pons ⁃ Midbrairn Index (PMI) were used to evaluate the cerebral infarction range, and Post ⁃ Traffic Score and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading were used to evaluate the posterior circulation collateral compensation after actue BAO. The main prognostic indicators were immediate postoperative vascular recanalization rate, functional independence and prognosis 90 d after treatment, and the main safety endpoints were intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH) incidence 7 d after surgery and mortality 90 d after treatment. Results In tandem group, the lesions were mainly located at the beginning of the basilar artery (including the intracranial segment of the vertebral artery) and at the distal end ( P = 0.000), and the proportion of intracranial arterial stenosis was lower ( P = 0.000). Among the 25 patients with tandem lesion, 21 took the Dirty ⁃ road route and 4 took the Clean ⁃ road route. The proportion of stent thrombectomy ( P = 0.030) and intraoperative intravenous injection of tirofibana ( P = 0.028) was lower, the proportion of stent implantation was higher ( P = 0.005), the proportion of vascular recanalization after treatment was lower ( P = 0.001), and the mortality rate was higher 90 d after treatment ( P = 0.002). Univariate and multivariate Logistic regression analysis showed that acute BAO tandem lesion had a lower immediate vascular recanalization rate ( OR = 0.050, 95% CI: 0.010-0.530; P = 0.012) and a higher mortality 90 d after treatment (OR = 17.320, 95% CI: 2.700-111.040; P = 0.003). Conclusions Tandem lesion seems to be associated with low rate of recanalization and high rate of mortality in patients with acute BAO.DOI：10.3969/j.issn.1672⁃6731.2020.05.005