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 first-pass effect, but no statistically significant independent association with 90-day functional independence or final recanalization rates.
Patients with poor B.A.D. scores (≥2) had significantly longer puncture-to-recanalization times than those with good B.A.D. scores (<2).
The first-pass effect (FPE) rate was lower in the poor B.A.D. group in unadjusted comparison.
Poor B.A.D. status remained independently associated with lower odds of FPE success after adjustment for thrombectomy technique and clinical covariates.
Poor B.A.D. status remained independently associated with longer puncture-to-recanalization time in a procedurally adjusted linear regression model.
Final recanalization rates did not differ between the good and poor B.A.D. groups.
90-day functional independence (mRS 0-2) was numerically lower in the poor B.A.D. group, but the difference was not significant and there was no independent association in multivariable analysis.
The authors conclude that the B.A.D. score may have potential as a preprocedural marker of vascular access complexity but needs prospective external validation before use in procedural planning.
This study looked at whether difficult blood-vessel anatomy on the way to a brain clot affects how well clot-removal procedures (mechanical thrombectomy) work in stroke. Researchers reviewed 220 patients with a clot in a major brain artery (the proximal MCA M1 segment). They grouped patients by the Bovine Aortic Arch-Dolichoarteriopathy (B.A.D.) score, which captures an aortic arch branching variant and elongated, tortuous arteries. Patients with scores of 2 or more were considered to have poor access anatomy. Patients with poor B.A.D. anatomy took longer to have the clot removed, with a median of 67 minutes from puncture to recanalization vs. 43 minutes. They were also less likely to have the clot removed on the first attempt (37.7% vs. 51.7%). These differences remained after accounting for other clinical and procedural factors. However, the final success of reopening the vessel was similar in both groups. Patients with poor anatomy were less often functionally independent at 90 days (51.9% vs. 63.6%), but this difference could have occurred by chance and was not independently linked to the B.A.D. score. This research suggests the B.A.D. score might help identify patients whose procedures will be technically harder before the procedure begins. The study was retrospective and done at one center, so the results need confirmation in prospective, external studies before the score is used to plan procedures.
Erdogan M, Acar B, Yıldız M, Eryılmaz H, Zafer E, Boncuk Ulaş S. (2026). Vascular Access Complexity and Thrombectomy Efficiency in Proximal MCA M1 Occlusion: Evaluation of the Bovine Aortic Arch-Dolichoarteriopathy Score.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62101933