E-045 Early neurological improvement is independent predictor of favorable outcome following thrombectomy for basilar artery occlusion

Background Acute ischemic stroke from basilar artery occlusion (BAO) is a devastating disease with high mortality and morbidity rate. The safety and efficacy of endovascular thrombectomy in BAO is not fully understood. We aimed to evaluate the predictors of favorable clinical outcome in these patients. Methods We performed a retrospective analysis of consecutive acute stroke patients with BAO whom underwent endovascular thrombectomy. Demographics, and the rate of successful recanalization (TICI score ≥2B) were reviewed. The primary efficacy outcome was defined as 90-day modified Rankin Scale (mRS) score ≤ 2 (or no worsening of mRS at 90 days compared to pre-stroke mRS in patients with pre-stroke mRS>2). Secondary outcome included early neurological improvement (ENI) defined as ≥8 points reduction in National Institutes of Health Stroke Scale (NIHSS) score, as compared to presentation, or NIHSS score ≤4 at 24 hours. Multivariate analysis was performed to determine predictors of favorable 90-day outcome. Results Sixty-two patients were identified with mean (SD) age 67 (15), 39% women, and 24% African-American. Initial NIHSS median (IQR) was 22 (14), the mean symptoms onset to groin puncture time was 9.7 (5.7) hours. Thirty-one percent of patients were treated with intravenous thrombolytic therapy. Successful recanalization was achieved in 92% of the patients. Total of 34% of the patients had favorable 90-day outcome. Mortality at 90-day was seen in 34% of the patients. ENI was observed in 22 (35%) patients. Patients with ENI were more likely to have favorable 90-day clinical outcome, compared to those without ENI (52% vs 27%, p=0.04). Single pass successful recanalization (OR; 95% CI: 5.56; 1.61–19.81, p=0.005) and initial NIHSS score (OR; 95% CI: 1.11; 1.2–1.19, p=0.043) were independent predictors of ENI. Conclusion ENI is an independent predictor of favorable clinical outcome after BAO thrombectomy. Single pass successful recanalization is associated with higher likelihood of ENI. Disclosures S. Majidi: 1; C; SNIS Foundation. S. Matsoukas: None. R. De Leacy: None. T. Oxley: None. H. Shoirah: None. T. Shigematsu: None. C. Kellner: None. J. Mocco: None. J. Fifi: None.