Plasma Homocysteine and Prognosis of Patients with Recanalization after Acute Basilar Artery Occlusion: An Analysis from the Acute Basilar Artery Occlusion Study (BASILAR) Nationwide Prospective Registry

Background: Few studies have investigated the association between plasma Homocys-teine (Hcy) levels in patients with recanalization after acute Basilar Artery Occlusion (BAO). Objective: This study investigated the predictive value of Hcy on the clinical prognosis of patients with recanalization after acute BAO. Methods: Altogether, 829 participants were recruited from the standard medical treatment plus en-dovascular treatment group of the Acute Basilar Artery Occlusion Study (BASILAR). Hcy levels were measured the morning after admission. The primary outcome was a combination of death and major disability (modified Rankin Scale score 4-6) at 90 days, and the secondary outcome was the mortality of patients with recanalization after acute BAO within 90 days. We used multivariable lo-gistic regression modeling to estimate the association between Hcy and prognosis in our partici-pants at 90 days. Results: Altogether, 647 patients were assessed, and 302 patients were included in this study. The median was 12.88 mu mol/L, and the mean Hcy concentration was 15.49 mu mol/L. Elevated plasma Hcy levels (Hcy >12.88 mu mol/L) were associated with poor functional outcomes (adjusted odds ra -tio 1.922, 95% confidence interval (CI) 1.048-3.528, P=0.035), but not with mortality (adjusted odds ratio 1.605, 95% CI 0.986-2.489, P=0.058). In further subgroup analysis, the conclusion was consistent in all predefined subgroups. Conclusion: Our analysis suggests that elevated plasma Hcy levels have a predictive value for func-tional outcomes in patients with recanalization after acute BAO during the 90-day follow-up peri-od, but not for mortality.