Nomogram for Predicting 90-day Outcomes in Patients with Acute Vertebrobasilar Artery Occlusion Undergoing Endovascular Treatment: A Multicenter Cohort Study

ABSTRACT

BACKGROUND AND PURPOSE:

In this study, we aimed to develop and validate a novel nomogram model for predicting 90-day non-favorable clinical outcomes in patients with acute vertebrobasilar artery occlusion after endovascular treatment by integrating clinical and MRI features.

MATERIALS AND METHODS:

This multicenter retrospective study analyzed data from 181 patients with vertebrobasilar artery occlusion eligible for endovascular treatment from two Chinese stroke centers. We developed a predictive model for non-favorable clinical outcomes (modified Rankin Scale score >3) using the data of 125 patients from Stroke Center A (2019–2023). The model was constructed using univariate and multivariate logistic regression analyses of clinical and MRI characteristics, with continuous variables dichotomized based on receiver operating characteristic curve analysis. Internal validation employed smooth bootstrapping, while external validation utilized 56 cases from Stroke Center B (2019–2023), ensuring model reliability and generalizability across diverse clinical settings.

RESULTS:

Age, NIHSS baseline score, recanalization, novel posterior circulation scores, and MRA-based posterior circulation collateral scores were independent predictors of 90-day prognosis, which were used to create a nomogram model. Internal validation demonstrated excellent discriminative performance of the model (mean area under the curve, 0.92 [95% CI: 0.91–0.93]), while external validation further confirmed its robust generalizability (area under the curve, 0.88). The patients were effectively stratified into the low-risk and high-risk groups using the nomogram model.

CONCLUSIONS:

The posterior circulation collateral score was an independent predictor of prognosis. Our novel nomogram model, based on clinical and MRI characteristics, effectively predicts 90-day non-favorable clinical outcomes in patients with vertebrobasilar artery occlusion following endovascular treatment. ABBREVIATIONS: AUC = area under the curve; ETO = estimated time of onset; EVT = endovascular treatment; FCO = favorable clinical outcome; mTICI = modified TICI; Novel-PCS = novel posterior circulation score; pc-ASPECTS = posterior circulation Acute Stroke Prognosis Early CT score; PC-CS = posterior circulation collateral score; ROC = receiver operating characteristic; VBAO = vertebrobasilar artery occlusion