Evaluation Of Efficacy And Influencing Factors For Prognoses In Patients With Acute Basilar Artery Occlusion Treated With Intravenous Thrombolysis Bridging To Endovascular Thrombectomy

Part I Comparing the Efficacy of Bridging Therapy with Direct Endovascular Thrombectomy in Patients with Acute Basilar Artery OcclusionObjective: To investigate whether bridging therapy differs from direct endovascular thrombectomy(EVT)for achieving better outcome in patients with acute basilar artery occlusion(BAO).Methods: Data were analyzed from the prospective ATTENTION Registry(2017–2021)and 1,557 patients who received EVT were included in the study after screening.The primary endpoint was good functional outcome at 90 days defined as a modified Rankin Scale(m RS)score 0 to 3.Secondary endpoints were successful reperfusion defined as a modified Thrombolysis in Cerebral Infarction(m TICI)score of 2b to 3,m RS 0 to 1 and0 to 2,and the degree of disability measured by ordinal m RS score at 90 days.Safety outcomes included symptomatic intracranial hemorrhage(s ICH)and mortality.Multivariable binary and ordinal logistic regressions were performed to examine the association between treatment modalities and outcomes.Results: There were 1,557 patients included in this analysis,of whom 375(24.1%)were treated with bridging therapy,and 1,182(75.9%)were treated with direct EVT.Patients who received bridging therapy had a higher rate of hyperlipidaemia(P<0.05)and shorter time from onset to admission(P<0.05),onset to puncture(P<0.05)and onset to recanalization(P<0.05).Compared with patients who received direct EVT,patients with bridging therapy had similar odds of good functional outcome(P=0.153)but significantly lower mortality within 90 days(P<0.001).Bridging therapy was associated with a milder degree of disability(P=0.014).Successful reperfusion(P=0.945)and s ICH(P=0.834)did not differ between groups.Conclusion: Patients with acute BAO who received bridging therapy had a similar rate of good functional outcome but lower mortality than those who received direct EVT within 90 days.Part II Influencing Factors for Prognoses of Patients with Acute Basilar Artery Occlusion after Bridging TherapyObjective: To investigate the influencing factors that lead to poor functional outcome in patients with acute basilar artery occlusion(BAO)receiving bridging therapy.Methods: We enrolled all patients who received bridging therapy for 404 from the ATTENTION Registry.According to the m RS score at 90 days after bridging therapy,they were divided into good functional outcome group(m RS score≤2,156 patients)and poor functional outcome group(m RS score>2,248 patients).The data of clinical,imaging and score of scales were collected.The differences of baseline characteristics between two groups were compared,and multivariate logistic regression were used to evaluate the predictors of poor functional outcome.Results: In all 404 BAO patients who received bridging therapy,there were 156(38.6%)had a good functional outcome and 248(61.3%)had a poor functional outcome.Compared with the good functional outcome group,patients in the poor functional outcome group were older,had higher admission National Institutes of Health Stroke Scale(NIHSS)scores,a lower proportion of single thrombectomy and successful rezanalication,and the different distribution of occlusion sites,all with statistically significant differences(P<0.05).The variables which were statistically significant in the comparison of baseline characteristics were included in the multivariate logistic regression analysis,and the results showed that poor functional outcome was associated with higher admission NIHSS scores(P=0.002),non-distal BAO(P=0.002),multiple thrombectomy(P=0.003)and failing to get successful rezanalication(P=0.040)in acute BAO patients treated with bridging therapy.Conclusion: In patients with bridging therapy,higher admission NIHSS scores,non-distal BAO,multiple thrombectomy and failing to get successful recanalication were independent risk factors of poor functional outcome.