Collateral Status Combined with Preprocedural SII predicts the risk of futile recanalization in acute BAO patients: a randomized controlled trial

Abstract Background: Endovascular therapy (EVT) that might improve the outcome of patients with acute basilar artery occlusion remains controversial. The objective of this study was to investigate functional outcomes at 3 months after endovascular therapy in patients with acute basilar artery occlusion (ABAO) and to predict the futile recanalization. Methods: The clinical data of acute basilar artery occlusion patients treated with endovascular therapy was collected from January 2019 to October 2022. Using the angiographic collateral grading system for basilar artery occlusion (ACGS-BAO) to evaluate collateral status. Futile recanalization was defined as an mRS score of 3-6 at 3 months. Association of ACGS-BAO and the preprocedural SII with futile recanalization was analyzed using logistic regression models. Results: The analysis of acute basilar artery occlusion patients showed that 47(64.38%) developed futile recanalization and 23(31.5%) died of 73 patients. Multivariate logistic analysis showed that ACGS-BAO (OR= 0.281, 95% CI = 0.132-0.600) and ln(SII) (OR= 2.482, 95% CI = 1.308-4.707) were independently associated with futile recanalization. In receiver operating characteristic analysis, the area under the curve for ACGS-BAO and SII were 0.737 and 0.703 (95% CI= 0.617-0.857, P＝0.001 and 95% CI=0.582-0.824, P=0.001), respectively. The effects of ACGS-BAO and ln(SII) on futile recanalization were similar in all subgroups (P> 0.10 for all interactions). Conclusion: Our study suggested that bad collateral status and high inflammatory levels are independent predictors of futile recanalization after endovascular treatment in patients with ABAO.