Recanalization is more important than procedure time on outcome of thrombectomy in acute vertebrobasilar artery occlusion.

Abstract

Longer procedure time (PT) predicts worse prognosis after endovascular treatment (EVT) in acute vertebrobasilar artery occlusion (VBAO), but it remains unknown whether it is worth pursuing recanalization when the PT is obviously extended. Patients with acute VBAO who received EVT were retrospectively enrolled from 21 stroke centers in China from December 2015 to December 2018. Multivariable logistic analysis was performed to analyze the associations of PT with favorable outcome (defined as modified Rankin Scale score of 0 to 3) and mortality at 90 days. A total of 541 patients with median age of 64 years (IQR, 55-73) were included. The median baseline National institutes of Health stroke scale score was 23 (IQR, 14-28) and PT was 110 min (IQR, 74-156). The rate of favorable outcome was 36.5% in patients with PT 111-155 min (adjusted OR 0.51 [95% CI 0.28-0.92]) and 33.3% in patients with PT > 155 min (adjusted OR 0.52 [95% CI 0.29-0.93]) compared with 42.9% in patients with PT ≤ 75 min. Compared with the PT ≤ 75 min, PT of 111-155 min (adjusted OR 1.96 [95% CI 1.11-3.46]) and PT > 155 min (adjusted OR 2.10 [95% CI 1.21-3.66]) were associated with increased risks of mortality. Recanalization within four PT intervals were consistently associated with better outcomes compared with failure of recanalization (all P < 0.05). For acute VBAO patients treated with EVT, recanalization regardless of PT was associated with improved prognosis than failure of recanalization, supporting the continued pursuit of recanalization despite the PT being obviously extended. The findings need validation in randomized controlled trials.