Clinical Predictors of 90-Day Mortality After Endovascular Treatment for Acute Basilar Artery Occlusion

OBJECTIVE: The mortality rate after endovascular treatment (EVT) in patients with acute basilar artery occlusion (ABAO) remains high. This study aimed to analyze the clinical factors associated with 90-day mortality following EVT. METHODS: We retrospectively analyzed patients with ABAO who underwent EVT within 24 hours of symptom onset in the Department of Neurology, Baotou Central Hospital, Inner Mongolia, China, between April 2017 and September 2023. A favorable functional outcome was defined as a modified Rankin Scale (mRS) score of 0-3 at 90-day follow-up, whereas poor outcome was defined as an mRS score of 4-6. Mortality was defined as an mRS score of 6 at 90 days. Univariate and multivariate analyses were performed to identify predictors of mortality. RESULTS: A total of 96 patients were included. Early reperfusion (modified Thrombolysis in Cerebral Infarction ≥ 2b) was achieved in 87 patients (90.6%). Fifty patients (52.1%) achieved a favorable outcome, while the overall mortality rate was 30.2%. Univariate analysis showed that baseline Glasgow Coma Scale, baseline National Institutes of Health Stroke Scale score, posterior circulation Alberta Stroke Program Early Computed Tomography Score, symptomatic intracranial hemorrhage, successful reperfusion, and onset-to-puncture time (OPT) were associated with mortality. In multivariable analysis (model 3, including percutaneous transluminal angioplasty (PTA) and stenting as salvage therapy), OPT (odds ratio OR 1.004; 95% confidence interval CI 1.002-1.007; P=0.002), successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥ 2b) (OR 0.058; 95% CI 0.004-0.804; P=0.034), and PTA as salvage therapy (OR 9.202; 95% CI 1.783-47.505; P=0.008) were identified as independent predictors of 90-day mortality. CONCLUSION: Prolonged OPT and the use of PTA as salvage therapy may lead to an increased 90-day mortality. In contrast, early successful reperfusion significantly reduces 90-day mortality in ABAO patients treated with EVT. Therefore, early reperfusion remains critical. Meanwhile, efforts should be made to shorten the OPT and to reduce the use of PTA as a salvage therapy for ABAO.