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Abstract TP145: Effects Of Collateral Compensation On Endovascular Treatment In Basilar Artery Occlusion


 Background:
 We evaluated the prognostic value of collateral compensation on endovascular treatment (EVT) in patients with basilar artery occlusion (BAO).
 
 
 Methods:
 Eligible participants from the Endovascular treatment for Acute Basilar Artery Occlusion Study with collected composite collateral score were included. The effects of standard medical treatment (SMT) alone versus EVT plus SMT for patients based on both categorical (0-1 vs 2-3 vs 4-5) and continuous composite collateral score were evaluated. The primary outcome was defined as a modified Rankin Scale score 0-3 at 90 days and safety outcomes included symptomatic intracerebral hemorrhage and mortality at 90 days.
 
 
 Results:
 In total, 828 patients were included: 108 patients with composite collateral score 0-1 (SMT: 11; EVT: 97), 495 with composite collateral score 2-3 (SMT: 101; EVT: 394), and 225 with composite collateral score 4-5 (SMT: 70; EVT: 155). EVT was associated with favorable outcome (adjusted OR with 95% CI, 3.86 [0.32-46.24], 6.92 [2.95-16.23], 6.98 [2.83-17.21], respectively). Multivariable logistic analysis revealed that patients with the anastomosis between the posterior cerebellar artery and the superior cerebellar artery (PICA-SCA anastomosis,
 P
 = 0.007) and composite collateral score ≥2 (
 P
 = 0.027) were significantly correlated with better outcomes after EVT. Furthermore, onset-to-puncture time (OPT) within 4 hours was a prognostic factor in the poor collateral subpopulation (
 P
 = 0.049).
 
 
 Conclusions:
 PICA-SCA anastomosis is a strong prognostic factor in patients with BAO after EVT. Patients of BAO with composite collateral score ≥2 favored EVT and patients with poor collateral status could profit from EVT with OPT ≤4 hours.
