Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion.

Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups. Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in MM group. Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N=66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.50 [95% confidence interval (CI), 1.36 – 154.37]) and reperfusion failure (eTICI < 2b67 (OR, 4.98 [95% CI, 1.25 – 19.90]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.49 [95% CI, 1.09 – 2.04]), stroke onset-to-door time less than 24 hours (OR, 5.27 [95% CI, 1.09 – 2.04]), near-total occlusions (OR, 4.92 [95% CI, 1.24 – 19.56]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.58 [95% CI, 1.02 – 2.46]), and lower BATMAN collateral scores (OR, 1.55 [95% CI, 1.08 – 2.23]) were predictive of END-IP. Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In primary EVT group, failure to achieve reperfusion, and distal basilar occlusion were associated with all-cause END. In MM group, higher SBP at presentation, onset-to-door time less than 24 hours, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.