Prognostic Value Of BACS-DSA Score In Patients With Acute Basilar Artery Occlusion After Endovascular Treatment

Background:The proportion of acute basilar artery occlusion in acute ischemic stroke is relatively low,accounting for about 1% [1],but it has a high disability rate and fatality rate.According to current studies,endovascular treatment as soon as possible after the onset of the disease to achieve blood reperfusion is the best choice to improve the prognosis of patients.With the updating and iteration of thrombectomy technology and equipment,the Recanalization rates of patients with ischemic stroke also increases,but the good prognosis rate of patients with posterior circulation infarction is only about 35% [2],which still has a high room for improvement.A number of studies have suggested that the good prognosis of patients with acute basilar artery occlusion after vascular opening is related to thrombotic load,collateral circulation and Pre-op NIHSS score.Objective:The purpose of this study was to investigate the predictive value of BACS-DSA,a score that quantified posterior circulation thrombotic load,primary collateral circulation(posterior communicating artery),and secondary collateral circulation(posterior inferior cerebellar artery,anterior inferior cerebellar artery,and superior cerebellar artery,in the prognosis of patients undergoing intravascular therapy for acute basilar artery occlusion under digital subtraction angiography(DSA).Methods:A retrospective analysis was conducted on 111 patients with acute basilar artery occlusion who received endovascular treatment in China-Japan Union Hospital of Jilin University from July 2016 to February 2022.BACS-DSA score was used to evaluate thrombotic load and collateral circulation.Cerebral infarction thrombolysis(m TICI)score 2b-3 was defined as successful recalculation,and a modified Rankin Scale(m RS)score ≤2 at 90 days was defined as good prognosis.Two neurointerventional physicians with many years of experience used the double-blind method to read and score the film.Multivariate Logistic regression analysis was used to determine the predictors of clinical outcomes.The receiver operating characteristic(ROC)curve was used to evaluate the area under the curve(AUC)and the optimal cutoff value.The BACS-DSA score was compared with PC-CS score,PC-CTA score and BATMAN score under DSA to evaluate the predictive efficacy of BACS-DSA score in predicting the prognosis of patients with acute BAO after endovascular treatment.Results:In the enrolled population,88.3%(98/111)achieved vascular recalculation(m TICI,grade 2b-3).36.0%(40/111)patients had good outcomes(90-day m RS Score 0-2).Puncture to Recannalization Time(PRT),PC-CS,NIHSS score before thrombus removal,puncture to recannalization time(PRT),and puncture to the first opening in the good prognostic group(90 days m Rs Score ≤2 points)and the bad prognostic group(90 days m Rs Score ≥3 points)There were statistically significant differences in score,PC-CTA score,BATMAN score and BACS-DSA score(P < 0.05).Multivariate binary logistic regression analysis showed that BATMAN score≥4.5 and BACS-DSA score ≥7.5 were independent predictors of good clinical outcome 90 days after intravascular therapy in patients with acute basilar artery occlusion.Receiver operating characteristic curve(ROC)analysis showed that the AUC of BACS-DSA score was 0.851(95%CI:0.781 ～ 0.921),the threshold for predicting good outcome was 7.5,the sensitivity was 0.750,the specificity was 0.803,and the Yoden index was0.553.The AUC of BATMAN score was 0.870(95%CI: 0.804 ～ 0.936),the critical value for predicting good prognosis was 4.5,the sensitivity was0.800,the specificity was 0.817,and the Yoden index was 0.617.Conclusion:Lower preoperative NIHSS score and smaller PRT time are independent predictors of good prognosis in patients treated with acute basilar artery occlusion,which is consistent with the results of previous studies;In our study,BACS-DSA score has predictive value for the prognosis of patients with acute basilar artery occlusion undergoing endovascular therapy;In our study,compared with BACS-DSA score,BATMAN score has slightly better prognostic value for patients with acute basilar artery occlusion undergoing endovascular treatment.