Vascular Access Complexity and Thrombectomy Efficiency in Proximal MCA M1 Occlusion: Evaluation of the Bovine Aortic Arch-Dolichoarteriopathy Score.
6 affiliations
- 1Department of Anatomy, Faculty of Medicine, Sakarya University, 54100 Sakarya, Türkiye.
- 2Department of Neurology, Faculty of Medicine, Sakarya University, 54100 Sakarya, Türkiye.
- 3Giresun Provincial Health Directorate, Bulancak Şehit Er Enver Erdogan Family Health Center, 28300 Giresun, Türkiye.
- 4Department of Neurology, Sakarya Training and Research Hospital, 54100 Sakarya, Türkiye.
- 5Department of Internal Medicine, Sakarya Training and Research Hospital, 54100 Sakarya, Türkiye.
- 6Lille Neuroendocrinology Team, Department of Lille Neuroscience and Cognition, University of Lille, 59000 Lille, France.
Abstract
Background and Objectives: In this study, it was aimed to investigate the relationship between the Bovine Aortic Arch-Dolichoarteriopathy (B.A.D.) score and the procedural characteristics of mechanical thrombectomy, recanalization success, and 90-day functional outcomes in patients with acute ischemic stroke with proximal M1 occlusion of the middle cerebral artery (MCA). Materials and Methods: A total of 220 adult patients who underwent mechanical thrombectomy for proximal MCA M1 occlusion were included in this retrospective, single-center cohort study. The patients were divided into good B.A.D. (<2; n = 143) and poor B.A.D. (≥2; n = 77) groups. Admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT Score (ASPECTS) scores, collateral status, thrombectomy time intervals, number of passes, first-pass effect (FPE), and Modified Thrombolysis in Cerebral Infarction (mTICI) recanalization grades were evaluated. The primary outcome was functional independence at day 90 (mRS 0-2). Associations with procedural and clinical outcomes were evaluated using multivariable logistic and linear regression analyses. Results: The puncture-to-recanalization time was significantly longer in the poor B.A.D. group [67 (50.5-88.0) min vs. 43 (32.0-65.0) min, p < 0.001], and the FPE rate was lower (37.7% vs. 51.7%, p = 0.046). After adjustment for thrombectomy technique and clinical covariates, poor B.A.D. remained independently associated with lower odds of FPE success (aOR = 0.439, 95% CI: 0.229-0.839; p = 0.013). In the procedurally adjusted linear regression model, poor B.A.D. also remained independently associated with longer puncture-to-recanalization time after additional adjustment for the number of thrombectomy passes and thrombectomy technique (B = 0.294, 95% CI: 0.188-0.400; p < 0.001). Final mTICI ≥ 2b, ≥2c, and 3 recanalization rates did not differ between the groups. Although 90-day functional independence was lower in the poor B.A.D. group, the difference was not significant (51.9% vs. 63.6%, p = 0.092), and no statistically significant independent association between B.A.D. status and 90-day functional independence was observed in the multivariable analysis. Conclusions: Poor B.A.D. anatomy was associated with greater procedural complexity during mechanical thrombectomy for proximal MCA M1 occlusion, including longer puncture-to-recanalization time and lower odds of FPE success, even after adjustment for available procedural and clinical factors. However, no statistically significant independent association was demonstrated between B.A.D. status and 90-day functional independence, and final recanalization rates did not differ significantly between the groups. These findings suggest that the B.A.D. score may have potential value as a preprocedural marker of vascular access complexity; however, prospective external validation is required before its use for procedural planning can be recommended.
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BibTeX
@article{erdogan2026vascular,
title = {{Vascular Access Complexity and Thrombectomy Efficiency in Proximal MCA M1 Occlusion: Evaluation of the Bovine Aortic Arch-Dolichoarteriopathy Score.}},
author = {Mehtap Erdogan and Bilgehan Atılgan Acar and Mehmet Yıldız and Halil Alper Eryılmaz and Enes Zafer and Sena Boncuk Ulaş},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = oct,
doi = {10.3390/medicina62101933},
url = {https://europepmc.org/article/MED/42942463},
note = {CC BY},
}
RIS
TY - JOUR
TI - Vascular Access Complexity and Thrombectomy Efficiency in Proximal MCA M1 Occlusion: Evaluation of the Bovine Aortic Arch-Dolichoarteriopathy Score.
AU - Mehtap Erdogan
AU - Bilgehan Atılgan Acar
AU - Mehmet Yıldız
AU - Halil Alper Eryılmaz
AU - Enes Zafer
AU - Sena Boncuk Ulaş
PY - 2026
DA - 2026/10/07
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101933
UR - https://europepmc.org/article/MED/42942463
AB - Background and Objectives: In this study, it was aimed to investigate the relationship between the Bovine Aortic Arch-Dolichoarteriopathy (B.A.D.) score and the procedural characteristics of mechanical thrombectomy, recanalization success, and 90-day functional outcomes in patients with acute ischemic stroke with proximal M1 occlusion of the middle cerebral artery (MCA). Materials and Methods: A total of 220 adult patients who underwent mechanical thrombectomy for proximal MCA M1 occlusion were included in this retrospective, single-center cohort study. The patients were divided into good B.A.D. (<2; n = 143) and poor B.A.D. (≥2; n = 77) groups. Admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT Score (ASPECTS) scores, collateral status, thrombectomy time intervals, number of passes, first-pass effect (FPE), and Modified Thrombolysis in Cerebral Infarction (mTICI) recanalization grades were evaluated. The primary outcome was functional independence at day 90 (mRS 0-2). Associations with procedural and clinical outcomes were evaluated using multivariable logistic and linear regression analyses. Results: The puncture-to-recanalization time was significantly longer in the poor B.A.D. group [67 (50.5-88.0) min vs. 43 (32.0-65.0) min, p < 0.001], and the FPE rate was lower (37.7% vs. 51.7%, p = 0.046). After adjustment for thrombectomy technique and clinical covariates, poor B.A.D. remained independently associated with lower odds of FPE success (aOR = 0.439, 95% CI: 0.229-0.839; p = 0.013). In the procedurally adjusted linear regression model, poor B.A.D. also remained independently associated with longer puncture-to-recanalization time after additional adjustment for the number of thrombectomy passes and thrombectomy technique (B = 0.294, 95% CI: 0.188-0.400; p < 0.001). Final mTICI ≥ 2b, ≥2c, and 3 recanalization rates did not differ between the groups. Although 90-day functional independence was lower in the poor B.A.D. group, the difference was not significant (51.9% vs. 63.6%, p = 0.092), and no statistically significant independent association between B.A.D. status and 90-day functional independence was observed in the multivariable analysis. Conclusions: Poor B.A.D. anatomy was associated with greater procedural complexity during mechanical thrombectomy for proximal MCA M1 occlusion, including longer puncture-to-recanalization time and lower odds of FPE success, even after adjustment for available procedural and clinical factors. However, no statistically significant independent association was demonstrated between B.A.D. status and 90-day functional independence, and final recanalization rates did not differ significantly between the groups. These findings suggest that the B.A.D. score may have potential value as a preprocedural marker of vascular access complexity; however, prospective external validation is required before its use for procedural planning can be recommended.
SN - 1010-660X
SN - 1648-9144
ER -