AUTHOR=Wang Lei , Sun Wen , Ping Lei , Chen Guofang , Fu Xinmin , Liu Leijing , Li Qiao , Yao Meixue 

TITLE=Predictors of functional deterioration from 90 days to 1 year after endovascular treatment for vertebrobasilar artery occlusion: a multicenter retrospective study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1671672

DOI=10.3389/fneur.2025.1671672

ISSN=1664-2295

ABSTRACT=ObjectiveTo investigate risk factors for delayed neurological deterioration (1-year mRS score > 90-day score) in patients with acute ischemic stroke due to vertebrobasilar artery occlusion (VBAO) after endovascular treatment (EVT), and to evaluate heterogeneity across age and sex subgroups.MethodsThis multicenter retrospective study included 1,342 VBAO patients who underwent EVT between December 2015 and June 2022. Based on dynamic changes in the mRS score, patients were categorized into a 1-year functional deterioration group (n = 288) and a functional stability group (n = 1,054). Multivariate binary logistic regression was used to identify factors associated with long-term functional deterioration. Stratified analyses were further performed by age (≤70 years vs. >70 years) and sex.ResultsAfter adjusting for demographics and clinical variables, the following factors were independently associated with 1-year functional deterioration (all p < 0.05): female sex (OR = 1.425, 95%CI:1.062–1.911), increasing age (per year) (OR = 1.016, 95%CI: 1.004–1.028), Door-to-Puncture Time (DTP) (OR = 1.001, 95%CI: 1.000–1.001), modified Thrombolysis in Cerebral Infarction (mTICI) score (2b, OR = 0.452, 95%CI: 0.234–0.874; 3, OR = 0.398, 95%CI: 0.213–0.742) and number of attempts(≥4, OR = 3.765, 95%CI: 1.601–8.854). Gender-stratified analysis shows age and DTP drive female outcomes; male outcomes are regulated by complex surgical factors. Age stratification reveals younger females have poorer improvement than males with equal reperfusion, while in older patients, operation count strongly impacts outcomes, with high-quality reperfusion buffering multiple operations’ harm.ConclusionThis study revealed that the functional outcomes of patients with VBAO from 90 days to 1 year after EVT exhibit distinct patterns, with the dominant influencing factors varying by gender and age group. This provides an important basis for the formulation of individualized treatment strategies.