Vascular Access Complexity and Thrombectomy Efficiency in Proximal MCA M1 Occlusion: Evaluation of the Bovine Aortic Arch–Dolichoarteriopathy Score

Abstract

Background and Objective: 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 Method: 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.