Nomogram Model for Predicting 90-Day Excellent Outcome in Patients With Acute Vertebrobasilar Artery Occlusion Undergoing Endovascular Thrombectomy.

BACKGROUND

Acute vertebrobasilar artery occlusion is associated with mortality rates up to 80%. While endovascular thrombectomy has proven effective, patient selection remains challenging due to limited validated prediction models. This study aimed to develop and externally validate a nomogram for predicting 90-day excellent functional outcome (modified Rankin Scale score, 0-1) in patients with acute vertebrobasilar artery occlusion undergoing endovascular thrombectomy.

METHODS

A total of 819 patients with vertebrobasilar artery occlusion undergoing endovascular thrombectomy were enrolled in this study. Of these, 242 patients from 4 stroke centers were allocated to the training cohort, while 577 patients from the PERSIST (Posterior Circulation Ischemic Stroke) registry comprised the validation cohort. Multivariate logistic regression identified independent predictors for nomogram development. Model performance was assessed using the concordance index, calibration curves, and decision curve analysis.

RESULTS

The overall excellent outcome rate was 21.2%, with 85.1% achieving successful recanalization. Five independent predictors were identified: age <65 years (odds ratio [OR], 0.96; P=0.006), baseline National Institutes of Health Stroke Scale score <18 (OR, 0.97; P=0.012), thrombectomy passes <3 (OR, 0.59; P=0.033), Basilar Artery on Computed Tomography Angiography score >6 (OR, 1.34; P=0.028), and successful recanalization (OR, 4.49; P=0.019). The nomogram demonstrated excellent discriminative performance, with a concordance index of 0.82 in the training cohort and 0.92 in external validation. Good calibration was confirmed (Hosmer-Lemeshow test, P=0.514).

CONCLUSIONS

We developed and externally validated a practical nomogram incorporating 5 clinical variables for predicting excellent outcomes in patients with acute vertebrobasilar artery occlusion undergoing endovascular thrombectomy. The model demonstrates robust performance and clinical utility, providing valuable support for evidence-based decision making in posterior circulation stroke management.