{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:42:32Z","timestamp":1781829752697,"version":"3.54.5"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Determining the underlying etiology of acute vertebrobasilar artery occlusion (VBAO) is crucial for selecting an appropriate treatment approach. The authors aimed to investigate the distribution of etiology and the association with functional outcomes in patients with acute VBAO who underwent endovascular treatment in which atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) phenotyping was used.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective study was conducted at 21 centers in China, involving patients with VBAO who received endovascular treatment within 24 hours of the estimated occlusion time. In the ASCOD phenotyping, each phenotype is graded based on the following categories: 1, likely to be causal; 2, uncertain if causal; and 3, unlikely to be causal. The authors defined a single possible cause as a cause graded 1 in a single domain, and multiple possible causes were graded 1 or 2 regardless of overlap. The primary outcome was unfavorable outcome (modified Rankin Scale [mRS] score of 3\u20136) at 90 days. The secondary outcomes included shift of mRS score at 90 days, 90-day mortality, successful reperfusion, and National Institutes of Health Stroke Scale score at 24 hours. Multivariable regression analysis was used to assess the association between etiological subtypes and functional outcomes. Multivariate competing-risk regression analysis was performed to analyze the association between etiological subtypes and the risk of recurrent stroke.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 577 patients were included in this study. Of these, 521 (90%) had a single possible cause. The most common etiology was A1 (382 cases, 73%), followed by C1 (111 cases, 21%) and O1 (28 cases, 5%\u2014in this study the other causes and dissection subtypes were categorized under the umbrella term of \"O\" causes). Similar patterns were observed in the multiple possible causes. In the baseline characteristics of the cohort, as rescue therapy, stenting was more frequently used in patients in the A1 group than in the C1 group (53.2% vs 41.7%; p &lt; 0.01). The proportion of atherosclerosis-type etiology increased when the occlusion was located more proximally (p &lt; 0.01). Compared to the A1 group, patients in the C1 group had a lower incidence of unfavorable outcome (OR 0.42, 95% CI 0.24\u20130.73), which was less likely to shift to a worse mRS score (OR 0.60, 95% CI 0.39\u20130.91). The O1 subtype was not associated with unfavorable outcome (OR 1.35, 95% CI 0.46\u20134.01), whereas patients with the O1 subtype were more likely to shift to worse mRS score (OR 2.39, 95% CI 1.09\u20135.25) and to have a higher 90-day mortality rate (OR 2.60, 95% CI 1.07\u20136.31). Furthermore, there was no significant association between single etiological subtypes and stroke recurrence within 1 year.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The most common etiology in patients with VBAO was atherosclerosis, followed by cardiac pathology and other. Compared to the A1 subgroup, the C1 subgroup showed better functional outcomes, whereas the O1 subgroup showed worse outcomes. Additionally, there was no statistically significant difference in the recurrence risk.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.1.jns232508","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T01:26:00Z","timestamp":1714181160000},"page":"983-991","source":"Crossref","is-referenced-by-count":1,"title":["ASCOD phenotyping of acute vertebrobasilar artery occlusion treated by mechanical thrombectomy: insight from the PERSIST registry"],"prefix":"10.3171","volume":"141","author":[{"given":"Miaomiao","family":"Hu","sequence":"first","affiliation":[{"name":"Graduate School of Bengbu Medical University, Bengbu, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Weinan, Shanxi, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huanhuan","family":"Luan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Lu\u2019an Fourth People\u2019s Hospital, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zuo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital of Traditional Chinese Medicine of Feidong, Hefei, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanlu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songlin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital of Traditional Chinese Medicine of Feidong, Hefei, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second People\u2019s Hospital of Huoqiu County, Lu\u2019 an, Anhui, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Sun","sequence":"additional","affiliation":[{"name":"Graduate School of Bengbu Medical University, Bengbu, Anhui, China;"},{"name":"Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Stroke","first-page":"389","article-title":"Vertebral artery patency and thrombectomy in basilar artery occlusions","volume":"50","author":"Boeckh-Behrens T","year":"2019","unstructured":"Boeckh-Behrens T, Pree D, Lummel N. Vertebral artery patency and thrombectomy in basilar artery occlusions. Stroke. 2019;50(2):389\u2013395."},{"issue":"10","key":"b2","series-title":"Stroke","first-page":"1216","article-title":"Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease","volume":"19","author":"Hacke W","year":"1988","unstructured":"Hacke W, Zeumer H, Ferbert A, Br\u00fcckmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988;19(10):1216\u20131222."},{"issue":"15","key":"b3","series-title":"N Engl J Med","first-page":"1361","article-title":"Trial of endovascular treatment of acute basilar-artery occlusion","volume":"387","author":"Tao C","year":"2022","unstructured":"Tao C, Nogueira RG, Zhu Y. Trial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med. 2022;387(15):1361\u20131372."},{"issue":"15","key":"b4","series-title":"N Engl J Med","first-page":"1373","article-title":"Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion","volume":"387","author":"Jovin TG","year":"2022","unstructured":"Jovin TG, Li C, Wu L,  Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med. 2022;387(15):1373\u20131384."},{"issue":"1","key":"b5","series-title":"Ann Neurol","first-page":"55","article-title":"Real-world outcomes of endovascular thrombectomy for basilar artery occlusion: results of the BArONIS study","volume":"94","author":"Dicpinigaitis AJ","year":"2023","unstructured":"Dicpinigaitis AJ, Dick-Godfrey R, Gellerson O,  Real-world outcomes of endovascular thrombectomy for basilar artery occlusion: results of the BArONIS study. Ann Neurol. 2023;94(1):55\u201360."},{"issue":"5","key":"b6","series-title":"JAMA Neurol","first-page":"561","article-title":"Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry","volume":"77","author":"Zi W","year":"2020","unstructured":"Zi W, Qiu Z, Wu D,  Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurol. 2020;77(5):561\u2013573."},{"issue":"8","key":"b7","series-title":"Stroke","first-page":"2468","article-title":"Etiology of large vessel occlusion posterior circulation stroke: results of the MR CLEAN registry","volume":"53","author":"Pirson FAVA","year":"2022","unstructured":"Pirson FAVA, Boodt N, Brouwer J,  Etiology of large vessel occlusion posterior circulation stroke: results of the MR CLEAN registry. Stroke. 2022;53(8):2468\u20132477."},{"issue":"1","key":"b8","series-title":"Stroke","first-page":"35","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment","volume":"24","author":"Adams HP Jr","year":"1993","unstructured":"Adams HP Jr, Bendixen BH, Kappelle LJ,  Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35\u201341."},{"issue":"5","key":"b9","series-title":"Cerebrovasc Dis","first-page":"502","article-title":"New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke","volume":"27","author":"Amarenco P","year":"2009","unstructured":"Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis. 2009;27(5):502\u2013508."},{"issue":"11","key":"b10","series-title":"J Neurointerv Surg","first-page":"1077","article-title":"Influence of renal impairment on clinical outcomes after endovascular recanalization in vertebrobasilar artery occlusions","volume":"14","author":"Xiao L","year":"2022","unstructured":"Xiao L, Gu M, Lu Y,  Influence of renal impairment on clinical outcomes after endovascular recanalization in vertebrobasilar artery occlusions. J Neurointerv Surg. 2022;14(11):1077\u20131083."},{"issue":"10","key":"b11","series-title":"J Neurol","first-page":"5561","article-title":"Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment","volume":"269","author":"Wang J","year":"2022","unstructured":"Wang J, Zhu S, Xu P,  Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment. J Neurol. 2022;269(10):5561\u20135570."},{"key":"b12","series-title":"Ther Adv Neurol Disord","first-page":"17562864221114627","article-title":"The safety and effectiveness of endovascular treatment for patients with vertebrobasilar artery occlusions: according to the BEST and BASICS criteria","volume":"15","author":"Sun W","year":"2022","unstructured":"Sun W, Duan Z, Xu P,  The safety and effectiveness of endovascular treatment for patients with vertebrobasilar artery occlusions: according to the BEST and BASICS criteria. Ther Adv Neurol Disord. 2022;15:17562864221114627."},{"key":"b13","series-title":"Front Endocrinol (Lausanne)","first-page":"1000030","article-title":"Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion","volume":"13","author":"Gu M","year":"2022","unstructured":"Gu M, Fan J, Xu P,  Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion. Front Endocrinol (Lausanne). 2022;13:1000030."},{"issue":"e2","key":"b14","series-title":"J Neurointerv Surg","first-page":"e270","article-title":"Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry","volume":"15","author":"Zhang P","year":"2023","unstructured":"Zhang P, Xu P, Duan Z,  Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry. J Neurointerv Surg. 2023;15(e2):e270\u2013e276."},{"issue":"10","key":"b15","series-title":"Acad Radiol","first-page":"e298","article-title":"Effectiveness of endovascular recanalization treatment for M2 segment occlusion: comparison between intracranial ICA, M1, and M2 segment thrombectomy","volume":"26","author":"Goebel J","year":"2019","unstructured":"Goebel J, Stenzel E, Wanke I. Effectiveness of endovascular recanalization treatment for M2 segment occlusion: comparison between intracranial ICA, M1, and M2 segment thrombectomy. Acad Radiol. 2019;26(10):e298\u2013e304."},{"issue":"9","key":"b16","series-title":"Stroke","first-page":"2485","article-title":"Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion","volume":"39","author":"Puetz V","year":"2008","unstructured":"Puetz V, Sylaja PN, Coutts SB,  Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke. 2008;39(9):2485\u20132490."},{"issue":"3","key":"b17","series-title":"Ann Neurol","first-page":"415","article-title":"Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study","volume":"77","author":"Singer OC","year":"2015","unstructured":"Singer OC, Berkefeld J, Nolte CH. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol. 2015;77(3):415\u2013424."},{"issue":"9","key":"b18","series-title":"Stroke","first-page":"2650","article-title":"Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement","volume":"44","author":"Zaidat OO","year":"2013","unstructured":"Zaidat OO, Yoo AJ, Khatri P,  Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44(9):2650\u20132663."},{"issue":"1","key":"b19","series-title":"Cerebrovasc Dis","first-page":"1","article-title":"The ASCOD phenotyping of ischemic stroke (updated ASCO phenotyping)","volume":"36","author":"Amarenco P","year":"2013","unstructured":"Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Wolf ME, Hennerici MG. The ASCOD phenotyping of ischemic stroke (updated ASCO phenotyping). Cerebrovasc Dis. 2013;36(1):1\u20135."},{"issue":"2","key":"b20","series-title":"J Stroke","first-page":"234","article-title":"Endovascular treatment in patients with cerebral artery occlusion of three different etiologies","volume":"22","author":"Lee D","year":"2020","unstructured":"Lee D, Lee DH, Suh DC,  Endovascular treatment in patients with cerebral artery occlusion of three different etiologies. J Stroke. 2020;22(2):234\u2013244."},{"issue":"3","key":"b21","series-title":"Neurotherapeutics","first-page":"613","article-title":"The future of ischemic stroke diagnosis and a review of underrecognized ischemic stroke etiologies","volume":"20","author":"Johansen MC","year":"2023","unstructured":"Johansen MC. The future of ischemic stroke diagnosis and a review of underrecognized ischemic stroke etiologies. Neurotherapeutics. 2023;20(3):613\u2013623."},{"issue":"7","key":"b22","series-title":"J Neurol","first-page":"1284","article-title":"Comparison of the new ASCO classification with the TOAST classification in a population with acute ischemic stroke","volume":"259","author":"Wolf ME","year":"2012","unstructured":"Wolf ME, Sauer T, Alonso A, Hennerici MG. Comparison of the new ASCO classification with the TOAST classification in a population with acute ischemic stroke. J Neurol. 2012;259(7):1284\u20131289."},{"issue":"2","key":"b23","series-title":"Clin Neuroradiol","first-page":"361","article-title":"Outcomes following mechanical thrombectomy in different etiological subtypes of acute basilar artery occlusion: stroke etiology and outcome after EVT in BAO","volume":"33","author":"Abdelrady M","year":"2023","unstructured":"Abdelrady M, Derraz I, Dargazanli C,  Outcomes following mechanical thrombectomy in different etiological subtypes of acute basilar artery occlusion: stroke etiology and outcome after EVT in BAO. Clin Neuroradiol. 2023;33(2):361\u2013374."},{"issue":"12","key":"b24","series-title":"Stroke","first-page":"e769","article-title":"ASCOD phenotyping of stroke with anterior large vessel occlusion treated by mechanical thrombectomy","volume":"52","author":"Fontaine L","year":"2021","unstructured":"Fontaine L, Sibon I, Raposo N,  ASCOD phenotyping of stroke with anterior large vessel occlusion treated by mechanical thrombectomy. Stroke. 2021;52(12):e769\u2013772."},{"issue":"2","key":"b25","series-title":"Transl Stroke Res","first-page":"230","article-title":"Analysis of treatment outcome after endovascular treatment in different pathological subtypes of basilar artery occlusion: a single center experience","volume":"12","author":"Sun X","year":"2021","unstructured":"Sun X, Raynald, Tong X,  Analysis of treatment outcome after endovascular treatment in different pathological subtypes of basilar artery occlusion: a single center experience. Transl Stroke Res. 2021;12(2):230\u2013238."},{"issue":"3","key":"b26","series-title":"Ann Clin Transl Neurol","first-page":"357","article-title":"Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy","volume":"5","author":"Lee WJ","year":"2018","unstructured":"Lee WJ, Jung KH, Ryu YJ,  Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy. Ann Clin Transl Neurol. 2018;5(3):357\u2013368."},{"issue":"3","key":"b27","series-title":"Eur Stroke J","first-page":"238","article-title":"Endovascular treatment for acute basilar artery occlusion due to different stroke etiologies of large artery atherosclerosis and cardioembolism","volume":"7","author":"Liu H","year":"2022","unstructured":"Liu H, Zeng G, Zeng H,  Endovascular treatment for acute basilar artery occlusion due to different stroke etiologies of large artery atherosclerosis and cardioembolism. Eur Stroke J. 2022;7(3):238\u2013247."},{"issue":"2","key":"b28","series-title":"Clin Neuroradiol","first-page":"483","article-title":"Exact basilar artery occlusion location indicates stroke etiology and recanalization success in patients eligible for endovascular stroke treatment","volume":"33","author":"Mutke MA","year":"2023","unstructured":"Mutke MA, Potreck A, Schmitt N,  Exact basilar artery occlusion location indicates stroke etiology and recanalization success in patients eligible for endovascular stroke treatment. Clin Neuroradiol. 2023;33(2):483\u2013490."},{"key":"b29","series-title":"J Neurointerv Surg","article-title":"Basilar artery occlusion location and clinical outcome: data from the ATTENTION multicenter registry","author":"Yu S","unstructured":"Yu S, Wang X, Guo Z,  Basilar artery occlusion location and clinical outcome: data from the ATTENTION multicenter registry. J Neurointerv Surg. Published online August 31, 2023. doi: 10.1136\/jnis-2023-020517"},{"issue":"10","key":"b30","series-title":"J Neurointerv Surg","first-page":"984","article-title":"Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment","volume":"11","author":"Hassan AE","year":"2019","unstructured":"Hassan AE, Shariff U, Saver JL,  Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment. 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