ArticleBMC neurology2025
A novel radiological score on digital subtraction angiography predicts prognosis for acute basilar artery occlusion treated with endovascular thrombectomy: a two-center retrospective study.
Article in BMC neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAcute basilar artery occlusion (BAO) carries high risks of disability and mortality. While endovascular thrombectomy (EVT) improves outcomes, reliable prognostic tools are needed. This study aimed to evaluate the prognostic value of the novel Basilar Artery and Posterior Circulation Collaterals (BAPCOR) score on digital subtraction angiography (DSA) for predicting clinical outcomes after EVT in acute BAO.
methodsA retrospective analysis was conducted on consecutive acute BAO patients treated with EVT at two comprehensive stroke centers (October 2020-January 2024). The BAPCOR score (15-point DSA-based system) assessed thrombus burden and posterior circulation collateral status. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3, and good outcome as modified Rankin Scale (mRS) ≤ 2 at 3 months. Multivariate regression and receiver operating characteristic (ROC) analyses identified predictors of outcome.
resultsAmong 98 acute BAO patients treated with endovascular thrombectomy, successful recanalization (mTICI 2b-3) was achieved in 91.8% (90/98), with 37.8% (37/98) attaining good functional outcomes (mRS ≤ 2) at 3 months. The novel BAPCOR score demonstrated strong prognostic value, showing an AUC of 0.821 (95% CI: 0.738-0.903) for predicting clinical outcomes. A BAPCOR score ≤ 5.5 optimally predicted poor outcomes with 89.2% sensitivity and 63.9% specificity. Patients with good outcomes had significantly higher median BAPCOR scores (9 vs. 5, P < .001). Multivariate analysis confirmed BAPCOR > 5.5 as an independent predictor of favorable outcomes (OR = 11.345; 95% CI: 3.137-41.591; P = .001), and the BAPCOR score outperformed the BATMAN-DSA score (AUC 0.821 vs. 0.735) in prognostic accuracy.
conclusionThe BAPCOR score demonstrated significant prognostic value for predicting clinical outcomes in acute BAO patients undergoing EVT. The scoring system's superiority stems from its comprehensive assessment of both thrombus burden (vertebrobasilar segments) and posterior circulation collaterals (including primary PCoA pathways and secondary cerebellar artery anastomoses), providing enhanced characterization of hemodynamic compensatory mechanisms.
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