Analysis Of The Impact Of Different Occlusion Mechanisms In The Posterior Circulation On Clinical Outcomes Of Endovascular Treatment

Objective: This study investigated the functional outcomes and safety of endovascular treatment in patients with posterior circulation stroke.It according to whether the underlying mechanism was arterial embolism or intrinsic atherosclerosis.Methods: Consecutive patients with posterior circulation ischemic stroke who were hospitalized in our center and received emergent endovascular treatment were enrolled from January 2018 to December 2021.Eligible subjects were divided into an embolism group and an intrinsic atherosclerosis group according to the details in the medical records and angiographic findings.The clinical manifestations,imaging findings,and treatment outcomes were analyzed retrospectively and compared between the two study groups using a logistic regression model,through calculating the odds ratios and95% confidence interval to illustrating the effects of embolism versus atherosclerotic mechanism on clinical outcomes after treatment.A subgroup analysis was performed for patients with basilar artery occlusion.Results: There were 58 patients in the embolism group and 50 in the intrinsic group.The significant between-group difference in time from onset to revascularization and the proportion of patients who underwent rescue treatment.At the same time,the rate of successful reperfusion(modified Thrombolysis in Cerebral Infarction score 2b–3)was comparable between the two groups(96.6% versus 90.0%;adjusted odds ratio[a OR] 0.73,95% confidence interval [CI] 0.01–42.74;P=0.88).There was no significant difference of the frequency of a moderate outcome in the embolism versus intrinsic group(modified Rankin Score [m RS] 0–3: 43.1% versus 58.0%;a OR 0.63,95%CI 0.15–2.50;P=0.51),frequency of a favorable outcome(m RS 0–2: 39.7% versus38.0%;a OR 1.59,95% CI 0.37–6.70;P=0.52),the 90-day mortality rate(34.5% versus26.0%;a OR 2.31,95% CI 0.50–10.63;P=0.28),or frequency of symptomatic intracranial hemorrhage(6.9% versus 2.0%,respectively;P=0.37).The subgroup analysis in patients with basilar artery occlusion found no significant between-group difference in any of the above-mentioned clinical outcomes(all P>0.05).Conclusion: The mechanism of posterior circulation occlusion has no significant effect on the functional outcome and procedural safety in patients with endovascular treatment.