Hyperdense Artery Sign and Clinical Outcomes After Endovascular Treatment in Acute Basilar Artery Occlusion

Jinrong Hu; Wencheng He; Bo Zheng; Fang Huang; Kefeng Lv; Jiasheng Liao; Zhao Chen; He Jiang; Kuiyun Wang; Hongjun Wang; Yang Lei; Jiachuan Liao; Hongfei Sang; Shuai Liu; Weidong Luo; Ruidi Sun; Jie Yang; Jiacheng Huang; Jiaxing Song; Fengli Li; Wenjie Zi; Chen Long; Qingwu Yang

doi:10.3389/fneur.2022.830705

Hyperdense Artery Sign and Clinical Outcomes After Endovascular Treatment in Acute Basilar Artery Occlusion

Front Neurol. 2022 Apr 25:13:830705. doi: 10.3389/fneur.2022.830705. eCollection 2022.

Authors

Jinrong Hu¹, Wencheng He², Bo Zheng³, Fang Huang⁴, Kefeng Lv⁵, Jiasheng Liao⁶, Zhao Chen³, He Jiang⁷, Kuiyun Wang⁸, Hongjun Wang⁹, Yang Lei¹⁰, Jiachuan Liao¹¹, Hongfei Sang¹, Shuai Liu¹, Weidong Luo¹, Ruidi Sun¹, Jie Yang¹, Jiacheng Huang¹, Jiaxing Song¹, Fengli Li¹, Wenjie Zi¹, Chen Long¹², Qingwu Yang¹

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
² Department of Neurology, Guiping People's Hospital, Guiping, China.
³ Department of Neurology, Yaan Peoples's Hospital, Yaan, China.
⁴ Department of Neurology, People's Hospital of Yuxi City, Yuxi, China.
⁵ Department of Neurology, Dongguan People's Hospital of Southern Medical University, Dongguan, China.
⁶ Department of Neurology, Suining No.1 People's Hospital, Suining, China.
⁷ Department of Neurology, The First People's Hospital of Neijiang, Neijiang, China.
⁸ Department of Neurology, The Jintang First People's Hospital, Jintang, China.
⁹ Department of Neurology, Fengdu People's Hospital, Fengdu, China.
¹⁰ Department of Neurology, Wulong District People's Hospital, Chongqing, China.
¹¹ Department of Neurology, Santai County People's Hospital of North Sichuan Medical College, Santai, China.
¹² Department of Emergency, Xiangtan Central Hospital, Chongqing, China.

Abstract

Background: This study aimed to investigate the association between the hyperdense basilar artery sign (HBAS) on non-enhanced computed tomography (CT) and clinical outcomes in patients with acute basilar artery occlusion (BAO) who underwent endovascular treatment (EVT).

Methods: Eligible patients who underwent EVT due to acute BAO between January 2014 and May 2019 were divided into two groups based on HBAS. HBAS was assessed by two neuroradiologists using five grades on nonenhanced CT. The primary outcome was a favorable functional outcome (defined as a modified Rankin Scale [mRS] of 0-3) at 90 days. Secondary outcomes included successful recanalization and mortality within 90 days.

Results: Among 829 patients with BAO as assessed with CT angiography, magnetic resonance angiography, or digital subtraction angiography, 643 patients were treated with EVT. Of these, 51.32% (330/643) had HBAS. Patients with HBAS were older and had more severe neurological deficits and a higher frequency of atrial fibrillation than those without HBAS. There was no significant difference in favorable outcome (adjusted odds ratio [aOR]: 1.354, 95% confidence interval [CI]: 0.906-2.024; p = 0.14), successful recanalization (aOR: 0.926, 95% CI: 0.616--1.393; p = 0.71), and mortality (aOR: 1.193, 95% CI: 0.839-1.695; p = 0.33) between patients with or without HBAS. Subgroup analysis showed that the HBAS predicted a favorable outcome in patients aged <60 years (aOR: 2.574, 95% CI: 1.234-5.368; p = 0.01) and patients with vertebral artery-V4 segment occlusion (aOR: 3.738, 95% CI: 1.212-11.530; p = 0.02). In patients with HBAS, the baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation-Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS), and stent retriever were associated with successful recanalization.

Conclusions: Our study did not find a significant association between HBAS and favorable outcomes and successful recanalization in patients with BAO who underwent EVT. Moreover, large prospective studies are warranted to further investigate this relationship.

Keywords: basilar artery occlusion; endovascular treatment; favorable outcome; hyperdense basilar artery sign; recanalization.