ISC 2025 | The impact of age and collateral status on outcomes of vertebrobasilar artery occlusion
Mohamed Doheim, MD, The University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, discusses an analysis of the impact of age and posterior circulation collateral status on outcomes in patients with vertebrobasilar artery occlusion undergoing endovascular thrombectomy. Dr Doheim highlights that age is a significant predictor of outcome, with older patients experiencing worse outcomes compared to younger patients, and the impact of collateral status is more pronounced in younger patients. This interview took place at the 2025 International Stroke Conference (ISC), held in Los Angeles, CA.
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Transcript
So as you know, vertebral basilar occlusion is associated with higher morbidity and mortality, and endovascular thrombectomy is the standard line of care supported by two positive trials, BAOCHE and ATTENTION, and the pooled analysis from VERITAS trial. However, there is a variability in terms of the outcome and the impact of age and collateral status is not well studied in this population. So we aimed to assess that in our study how the interaction between collateral and age and the effect on outcome would show if we were evaluating or testing that...
So as you know, vertebral basilar occlusion is associated with higher morbidity and mortality, and endovascular thrombectomy is the standard line of care supported by two positive trials, BAOCHE and ATTENTION, and the pooled analysis from VERITAS trial. However, there is a variability in terms of the outcome and the impact of age and collateral status is not well studied in this population. So we aimed to assess that in our study how the interaction between collateral and age and the effect on outcome would show if we were evaluating or testing that. That’s why we visited our database at UPMC Stroke Institute and reviewed it for 10 years, including 195 patients. We divided our patient based on age more than 80 and less than 80, and we divided our patient based on collateral status using the 10 grade BATMAN scale. It’s the 10 digit score and seven or above we consider that favorable while less than seven we consider that unfavorable. And when we compare the age it was pretty clear that patients who are older are doing worse compared to patients who are younger which would make sense because we know from anterior circulation models that age and NIHSS kind of predict the outcome. But the striking thing was when we divided them based on collateral status because we figured that in younger population less than 80, the patients with good collateral, robust collateral, are doing actually better than the patients with unfavorable collateral. Again, would make more sense, but in older populations, the patients with good collateral were as equal as the patients with unfavorable collateral, showing that yes, age is a predictor of the outcome associated with better or good functional outcome and yes, reduced mortality as well and yes, collateral status should lose outcome, but it’s more robust in younger population compared to older population. Of course, further studies like multicenter with larger sample size should confirm these results from our analysis.
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