Predictors of good outcome in Acute stroke due to basilar artery occlusion from the PC-SEARCH Registry
Adam Mierzwa1, Syed Zaidi2, Nameer Aladamat3, Khaled Gharaibeh4, Ehad Afreen5, Sami Al Kasab6, Ashley Nelson6, Santiago Ortega Gutierrez7, Juan Vivanco Suarez7, Mudassir Farooqui7, Ashutosh Jadhav8, Shashvat Desai9, Gabor Toth10, Anas Alrohimi11, Thanh Nguyen12, Klein Piers13, Mohamad Abdalkader13, Hisham Salahuddin14, Aditya Pandey15, Sravanthi Koduri15, Nirav vora16, Mouhammad Jumaa2
1Neurology, University of Toledo, 2ProMedica Stroke Network, 3The University of Toledo, 4ProMedica Neurosciences Center, 5Promedica Physicians Group Neurology, 6Medical University of South Carolina, 7University of Iowa, 8Barrow Neurological Institute, 9University of Pittsburgh Medical Center, 10Cleveland Clinic Foundation, 11University of Alberta, 12Boston Medical College, 13Boston University, 14Vascular Neurology of Southern California, 15University of Michigan, 16Ohio Health
Objective:
Evaluate the effect of race/gender and to identify predictors of good outcome in a cohort of patients with BAO treated with thrombectomy.
Background:
Acute Basilar Artery Occlusion (BAO) results in high rate of morbidity and mortality. Recent randomized controlled trials from China demonstrated clinical benefit of mechanical thrombectomy. Further studies are needed to understand the generalizability of the findings of these trials.
Design/Methods:
PC-SEARCH is a large multi-center retrospective registry of consecutive acute BAOs treated with thrombectomy at eight high-volume centers across the United States from July 2015 – December 2021. Patients were included in this registry if they received mechanical thrombectomy or intra-arterial thrombolysis within 24 hours of last seen normal. Registry includes data from baseline characteristics, pre- and intra- procedural data, radiographic and clinical outcomes. Good clinical outcomes were defined as mRS ≤ 3. Multivariate logical regression models were used to evaluate race and gender disparities and to identify significant predictors of good clinical outcomes.
Results:
PC-SEARCH captured 519 patients, 444 with completed 90-day mRS. The mean age was 65 Y, (SD 15), NIHSS mean was 17 (IQR 8-26), and PC-ASPECTS median was 10 ( IQR 8-10). Ethnicity was Caucasian (81%), Black (16%) and Asian (1.6%). Thirty nine percent of patients were females. Good recanalization (≥TICI 2b) was achieved in 82% of patients (N = 425). Forty-five percent of patients reached mRS ≤3 with overall mortality rate of 41.4% at 90 days. Fifty-four percent of patients treated within 6 hours. In multivariate analysis, TICI score (OR 4.58, CI 2.01 – 10.05; p = 0.00) and PC-ASPECTS (OR 2.05, CI 1.21 – 3.46; p = 0.01) were the only predictors of good outcome.
Conclusions:
Good recanalization and pre-procedural PC-ASPECT score are significant predictors of good outcomes for acute basilar artery occlusion who underwent thrombectomy in this registry. Race and gender did not predict outcomes.