Abstract
BACKGROUND AND PURPOSE: Acute vertebrobasilar artery occlusion (VBAO) is associated with high mortality and disability rates, and reliable prediction tools for post-endovascular therapy (EVT) outcomes remain limited. In this study, we aimed to develop and validate a novel Nomogram model for predicting 90-day unfavorable clinical outcomes in patients with acute VBAO after EVT by integrating clinical and MRI features. MATERIALS AND METHODS: This multicenter retrospective study analyzed data from 181 patients with vertebrobasilar artery occlusion eligible for endovascular therapy from 2 Chinese stroke centers. We developed a predictive model for unfavorable clinical outcomes (mRs score >3) by using the data of 125 patients from Stroke Center A (2019-2023). The model was constructed by using univariate and multivariate logistic regression analyses of clinical and MRI characteristics, with continuous variables dichotomized on the basis of receiver operating characteristic curve analysis. Internal validation used smooth bootstrapping, while external validation used 56 cases from Stroke Center B (2019-2023), ensuring model reliability and generalizability across diverse clinical settings. RESULTS: Age, NIHSS baseline score, recanalization, novel posterior circulation scores, and MRA-based posterior circulation collateral scores were independent predictors of 90-day prognosis, which were used to create a nomogram model. Internal validation demonstrated excellent discriminative performance of the model (mean area under the curve, 0.92;95% CI, 0.91-0.93), while external validation further confirmed its robust generalizability (area under the curve, 0.88). The patients were effectively stratified into the low-risk and high-risk groups using the nomogram model. CONCLUSIONS: The posterior circulation collateral score was an independent predictor of prognosis. Our novel nomogram model, based on clinical and MRI characteristics, effectively predicts 90-day unfavorable clinical outcomes in patients with vertebrobasilar artery occlusion following endovascular therapy.