The Predictive Value Of THRIVE Score For Outcomes Of Patients With Acute Basilar Artery Occlusion Treated By Thrombectomy

Background and Objective: Patients with basilar artery occlusion(BAO)still have poor outcomes even after successful revascularization.Based on the previous trials,the Totaled Health Risks in Vascular Events(THRIVE)score has been shown to predict outcomes after endovascular stent therapy(EST)in acute stroke patients.We attempted to evaluate THRIVE score in predicting outcomes of acute stroke patients with basilar artery occlusion and got good recanalization after EST.Our objection is to provide a selection tool for patients with acute basilar artery occlusion who accepted endovascular treatment and to quickly assess their prognosis and mortality.Methods: All patients with cerebral infarction because of basilar artery occlusion who got good revascularization(Thrombolysis in Cerebral Infarction(TICI)score =2b or 3)after treatment of thrombectomy by Solitaire AB stent were retrospected in our study from May 2014 to August 2018.According to their neural functional outcomes at 90 days from the onset,the patients were divided into group with good outcomes(Modified Rankin Score(mRS)< 2)or group with poor outcomes(mRS= 3-6)at 90 days.According to the 90-day mortality,the patients were divided into 25 cases(36.8%)with death and 43 cases(63.2%)with no death.And according to the CT findings after the operation,the patients were divided into 21 cases(30.9%)with intracranial hemorrhage and 47 cases(69.1%)with no intracranial hemorrhage.We collected the clinical baseline data of each group,recorded the surgical procedures and the intracranial hemorrhage during hospitalization,and followed up the all-cause mortality and prognosis at 90 days.We compared the baseline status during hospitalization between the two groups.We also focused on the assessment of the correlation between THRIVE score with intracranial hemorrhage during hospitalization and outcomes of the patients.SPSS version 22.0 was used for statistical analysis,and P < 0.05 was considered as significant difference.Results: 1.A total of 68 patients were included in our study.In comparison with participants with good functional outcome,those with poor functional outcome were more likely to be older(P<0.05),had more severe stroke(higher NIHSS)(P<0.05),tend to with higher THRIVE score(P<0.05).Multivariate regression analysis showed that THRIVE score was associated with poor functional outcomes(OR=0.180,95% CI: 0.07~0.458,P<0.001).2.25(36.8%)patients died during 90-day follow-up.Univariate analysis showed that the history of diabetes(P=0.004)and the THRIVE score(P<0.001)were associated with 90-day all-cause mortality.Multivariate regression analysis showed that THRIVE scores(OR=2.397,95% CI 1.323-4.343,P=0.004)and total cholesterol(OR=0.554,95% CI 0.314-0.976,P=0.041)were significantly associated with 90-day mortality of patients.3.21 patients(30.9%)got intracranial hemorrhage during hospitalization.Univariate analysis showed that gender(P=0.049)and history of coronary heart disease(P=0.033)were associated with intracranial hemorrhage.Multivariate regression analysis showed that THRIVE score(OR=1.648,95% CI: 0.679~1.940,P=0.607)and NIHSS score(OR=1.025,95% CI: 0.944~1.113,P=0.599)were not associated with intracranial hemorrhage.4.For predicting 90-day poor functional outcome,the AUC of THRIVE score was 0.913(cutoff > 5),and the AUC for NIHSS score was 0.748(cutoff >18),P=0.0069;For predicting 90-day mortality,the AUC of THRIVE score was 0.768(cutoff > 5),while NIHSS score was 0.606(cutoff > 22),P=0.0175;The AUC for NIHSS score was similar to THRIVE score for predicting intracranial hemorrhage(AUC=0.612 vs AUC=0.616,P=0.9568).Conclusions: High level of THRIVE score predicted patients with poor long-term outcome and mortality even when the patients got good recanalization after endovascular stroke treatment.Patients with high THRIVE scores have worse prognoses.THRIVE score was not associated with intracranial hemorrhage.THRIVE score had a higher predictive value for long-term poor prognosis and mortality compared with the NIHSS score.THRIVE score can quickly predict neuronal functional outcome and mortality before EST.This tool will be very helpful for doctors to choose treatment methods and evaluate the prognoses of these patients.