Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA.
Eur J Neurol. 2020 Nov;27(11):2176-2184. doi: 10.1111/ene.14406. Epub 2020 Jul 28.
Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision-making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO.
This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the USA and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day modified Rankin scale scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-Vertebrobasilar (POST-VB) score). The POST-VB score was evaluated and internally validated with regard to calibration and discriminatory ability. External validity was assessed in patient cohorts at three separate centers.
In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure magnetic resonance imaging (P < 0.01) and younger age (P = 0.01). POST-VB score was calculated as: age + (10 × brainstem infarct volume). POST-VB score demonstrated excellent discriminatory ability [area under the receiver-operating characteristic curve (AUC) = 0.91] and adequate calibration (P = 0.88) in the derivation cohort (Center A). It performed equally well across the three external validation cohorts (Center B, AUC = 0.89; Center C, AUC = 0.78; Center D, AUC = 0.80). Overall, a POST-VB score < 49 was associated with an 88% likelihood of favorable outcome, as compared to 4% with a score ≥ 125.
The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.
尽管基底动脉闭塞（BAO）患者实现了再通，但仍存在较高的发病率和死亡率。血流恢复与长期功能状态之间的差异使得临床决策难以确定是否需要进一步强化治疗。我们旨在开发并验证一种实用的、用于预测急性再灌注治疗后 3 个月预后的工具，以预测 BAO 患者的预后。
这是一项在美国和欧洲 4 家高容量卒中中心进行的回顾性、多中心、观察性研究。采用多变量回归分析确定有利结局（90 天改良 Rankin 量表评分 0-2）的预测因素，并得出一个临床适用的预后模型（匹兹堡卒中后取栓-椎基底动脉（POST-VB）评分）。评估 POST-VB 评分的校准和判别能力，并进行内部验证。在另外 3 个中心的患者队列中评估外部有效性。
在 59 例患者的推导队列中，有利结局的独立预测因素包括：术后磁共振成像上脑干梗死体积较小（P＜0.01）和年龄较小（P=0.01）。POST-VB 评分的计算方法为：年龄+（10×脑干梗死体积）。POST-VB 评分在推导队列（中心 A）中具有出色的判别能力[受试者工作特征曲线下面积（AUC）=0.91]和良好的校准度（P=0.88）。在另外 3 个外部验证队列（中心 B、中心 C 和中心 D）中，该评分表现同样良好（AUC 分别为 0.89、0.78 和 0.80）。总体而言，POST-VB 评分＜49 与 88%的有利结局相关，而评分≥125 与 4%的有利结局相关。
POST-VB 评分可有效预测急性再灌注治疗后 BAO 的 3 个月功能结局，并可能有助于指导术后治疗。
