Short And Long-term Mortality And Its Predictors Of Acute Vertebrobasilar Artery Occlusion With Endovascular Treatment

Part Ⅰ:Predictors of 90-day and 1-year mortality for acute vertebrobasilar artery occlusion receiving endovascular treatmentPurpose:Acute vertebrobasilar artery occlusion(VBAO)is a devastating type of stroke with a high mortality rate.This study aimed to investigate the predictors of 90-day and 1-year mortality in VBAO patients receiving endovascular treatment(EVT).Methods:Consecutive acute VBAO patients undergoing EVT between January 2014 and December 2019 were retrospectively analyzed.Multivariate logistical regression models were used to explore the potential predictors of mortality at 90 days and 1 year,respectively.The discrimination and calibration of the final model were assessed with the area under the receiver operating characteristic curve(AUC)and HosmerLemeshow test,respectively.Results:A total of 100 patients were enrolled in this study(mean age 62 years;77.0%male).After excluding patients lost to follow-up,the overall mortality rate was 34.3%(34/99)at 90 days and 45.4%(44/97)at 1 year.The Glasgow Coma Scale(GCS)score at 24h after EVT(Odds ratio[OR],0.676;95%confidence interval[CI],0.5400.846;P=0.001)and mechanical ventilation(MV)(OR,7.356;95%CI,2.20024.593;P=0.001)were predictors of 90-day mortality in multivariable analysis.Furthermore,the GCS score at 24h(OR,0.714;95%CI,0.590-0.864;P=0.001),intracranial hemorrhage(ICH)(OR,7.330;95%CI,1.772-30.318;P=0.006),and MV(OR,5.804;95%CI,1.841-18.294;P=0.003)were independently associated with mortality at 1 year.Sensitivity analyses showed similar results.Conclusion:The 24-hour GCS score after EVT and MV were common predictors of 90-day and 1-year mortality,and ICH was an additional predictor of 1-year mortality.Part Ⅱ:Outcomes in acute vertebrobasilar artery occlusion patients requiring respiratory managementPurpose:Most VBAO patients may require endotracheal intubation and MV.This study aimed to predict which patients may require respiratory management and who can survive at 90 days among these patients.Methods:Acute VBAO patients undergoing EVT between December 2011 and October 2020 were retrospectively analyzed.Multivariate analyses were performed to predict which patients had a high risk of intubation and MV and to build a model to explore the predictors of 90-day mortality among these patients.The discrimination and clinical performance of the final model were assessed using the AUC and decision curve analysis.Results:Of the 110 patients enrolled in this study(mean age 61.6 years;76.4%male),57(51.8%)patients were treated with intubation and 51(46.4%)followed by MV.Patients with lower baseline GCS score(OR,0.797;95%CI,0.708-0.898;P<0.001)and proximal basilar artery occlusion(OR,6.238;95%CI,2.067-18.822;P=0.001)were more likely to require respiratory management.Severe brainstem dysfunction(OR,17.010;95%CI,1.840-157.264;P=0.013)when intubated,neurological improvement(OR,0.036;95%CI,0.003-0.511;P=0.014)after intubation,and successful extubation(OR,0.123;95%CI,0.017-0.902;P=0.039)were independent predictors of 90-day mortality in acute VBAO patients with respiratory management.Conclusion:The prevalence of intubation and MV was quite high in acute VBAO patients.Patients without severe brainstem dysfunction,having neurological improvement after intubation,and successful extubation were more able to survive at 90-day follow-up.