Effect of metabolic syndrome on outcomes in vertebrobasilar artery occlusions following endovascular treatment: findings from the PERSIST registry

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Background: Acute vertebrobasilar artery occlusion (VBAO) is associated with severe neurological dysfunction and high mortality rates. Endovascular treatment (EVT) is a highly effective VBAO approach in the initial treatment window. However, predicted factors influencing the outcomes of VBAO patients who undergo EVT remain unknown. Our study aims to assess the impact of metabolic syndrome (Mets) on VBAO after EVT and to determine whether this factor can be influenced by reperfusion time. Methods: This retrospective study included a cohort of 569 patients with acute VBAO after EVT, who were enrolled across 21 stroke centers in China. The diagnosis of Mets was determined using the criteria established by the National Cholesterol Education Program (NCEP). The primary outcome was favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days post-treatment. To assess the impact of Mets and reperfusion time on the prognosis of VBAO patients, multivariable logistic regression analysis was performed. Safety outcomes, including symptomatic intracranial hemorrhage (sICH), in-hospital mortality, and 1-year mortality, were also evaluated. Results: Three hundred and thirty-four (58.70%) were being identified as having Mets in total 569 patients. After adjustment for potential confounding factors, a significant association appeared between Mets and favorable outcome at 90 days (OR, 0.547 [0.371, 0.807], p = 0.002). Additionally, the interaction was found between Mets and puncture to reperfusion time (PTR), which co-affects the favorable outcome (p for interaction < 0.001). Conclusions: VBAO patients with Mets have poor prognosis after being treated with EVT, with this prognosis more sensitive to PTR.

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