WSO October 2023 – Issue 1 - 977

Li et al.
977
Introduction
Basilar artery occlusion (BAO) accounts for approximately
1% of acute ischemic strokes (AISs) and 5% of
large vessel intracranial occlusion causing AIS.1,2 Acute
BAO patients tend to experience severe neurological
symptoms and other worse functional outcomes or death.3
The efficacy and safety in BAO patients undergoing endovascular
treatment (EVT) have been investigated in previous
studies.4-6 The Acute Basilar Artery Occlusion Study
(BASILAR) and Endovascular Treatment for Acute Basilar
Artery Occlusion (ATTENTION) registry study demonstrated
that EVT was associated with significantly better
functional outcomes and survival at 90 days.6 However,
acute BAO patients receiving EVT still have a high mortality
and disability rate. Hence, early and precise evaluation
tools are crucial for predicting clinical outcomes for
those patients.
Inflammation and immune responses have been shown
to have a significant effect on ischemic stroke. By
increasing oxidative stress, excitotoxicity, and thrombosis
in the acute stages of brain injury, they lead to neurological
deterioration and poor clinical outcomes.7 The
extensive relationship between clinical routine inflammatory
markers and stroke outcome has already been
confirmed.8 Neutrophils and platelets have been previously
regarded as drivers of inflammation and thrombotic
disease.9 Serum markers, including neutrophil-to-lymphocyte
ratio (NLR), platelet-to-lymphocyte ratio (PLR),
and white blood cell count (WBC), have been used to
quantify systemic inflammation.10 Previous studies have
found that the NLR is related to mortality in AIS11 and
worse clinical outcomes after EVT.12 In acute anterior
circulation occlusion stroke undergoing EVT, PLR may
be used to assess the risk of functional outcome.13 WBC
and neutrophils have a moderate ability to identify a large
vessel occlusion in AIS.14 Mean platelet volume (MPV)
can predict poor outcomes associated with anterior circulation
AIS patients receiving EVT.15 Therefore, these low
cost and clinically routine markers can easily be used in
evaluating inflammatory processes associated with poor
prognosis after AIS.
Previous studies mainly focused on anterior location
EVT with large vessel occlusion and few studies focused
on posterior circulation, especially for BAO. Convincing
results in previous studies had statistical limitations due to
small sample sizes. Furthermore, there is also a lack of
clinically valuable assessment of common inflammatory
markers. Using data from the ATTENTION registry, we
assessed low cost, clinically routine inflammatory parameters
(WBC, platelets count, neutrophil count, leukocyte
count, MPV, PLR, and NLR) to find correlations to clinical
outcomes in acute BAO patients receiving EVT.
Methods
Study population
The study protocol was approved by the ethics committee
of the first affiliated hospital of the University of Science
and Technology of China (2020KY-202). Written informed
consent was obtained from all patients or their legally
authorized representatives. This study was based on data
from the ATTENTION registry study,6 which is an ongoing,
nationwide, multicentre, pragmatic registry part of the
Chinese Clinical Trial Registry based on 48 comprehensive
stroke centers between March 2017 and February 2021
(https://www.chictr.org.cn; ChiCTR2000041117). Consecutive
acute BAO patients within 24 h of estimated time
of occlusion in basilar artery were included. Detailed study
methods and patient eligibility criteria have been reported
previously.6 The participating centers were capable of performing
more than 50 EVT per year. In those centers, intravenous
thrombolysis (IVT) and EVT were performed
simultaneously.
Treatments
IVT was treated by local neurologists based on a standard
alteplase dosage during the first 4.5 h after symptoms onset.
EVT included stent retrievers, balloon angioplasty, stent
deployment, thromboaspiration, and intra-arterial thrombolysis.
Bridging therapy (IVT + EVT) was defined as IVT
pretreatment with alteplase prior to EVT.
Collection of clinical information
The clinical information was collected including demographics,
medical history (hypertension, diabetes mellitus,
atrial fibrillation, hyperlipidemia, coronary heart disease,
transient ischemic attacks (TIAs), or stroke), blood pressure
on admission, smoking status, estimated time of symptom
onset of BAO to admission (OTA), estimated time of
symptom onset of BAO to puncture (OTP) and National
Institutes of Health Stroke Scale (NIHSS) score on admission,
laboratory information, imaging information, type of
treatment, complications, and functional outcomes. The
NIHSS score was used to evaluate neurological impairment.
The posterior circulation-Alberta Stroke Program
Early Computed Tomography Score (PC-ASPECTS) was
used to determine early ischemic changes. Collateral grades
from the
American Society of Interventional and
Therapeutic Neuroradiology/Society of Interventional
Radiology (ASITN/SIR) were evaluated. The participating
centers were required to confirm and revise any missing,
inconsistent, or extreme values.
International Journal of Stroke, 18(8)
https://www.chictr.org.cn
WSO October 2023 – Issue 1

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