Objectives Pre-endovascular identification of intracranial atherosclerotic stenosis – related large vessel occlusion (ICAS-LVO) is essential for optimizing recanalization strategy. This study aimed to develop a preoperative scale to predict ICAS-LVO in patients with acute vertebrobasilar artery occlusion (VBAO).Methods We retrospectively reviewed patients with acute VBAO who underwent endovascular thrombectomy at a single center between January 2015 and December 2024. The included patients were chronologically divided into a derivation cohort and a temporal internal validation cohort. ICAS-LVO was defined according to intra- or postprocedural angiographic findings. Candidate predictors were selected using a random forest approach, followed by regression-based model development. A prediction scale derived from the model was evaluated in both cohorts.Results A total of 196 patients were included for analysis, including 158 in the derivation cohort and 38 in the temporal internal validation cohort. Following random forest analysis, atrial fibrillation (AF), thrombus enhancement sign (TES), and occlusion site emerged as key predictors of ICAS-LVO. These variables were integrated into a multivariate logistic regression model. Subsequently, the ATO score – a weighted composite of these predictors – demonstrated robust discriminative performance, with an AUC of 0.939 (95% CI: 0.896–0.982, p < 0.001) in the derivation cohort and 0.929 (95% CI: 0.843–1.000, p < 0.001) in the temporal internal validation cohort.Discussion The ATO scale, which incorporates AF, TES, and the location of the occlusion site, may serve as a readily applicable instrument for predicting ICAS-LVO in VBAO patients before endovascular treatment.
Huang et al. (Tue,) studied this question.
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