Abstract TMP1: Infarct Location And Volumes As Predictors Of Outcome After Endovascular Recanalization Of Basilar Artery Occlusion

Abstract

Background and Purpose: Prognostic information after endovascular recanalization of basilar artery occlusion is important for guiding aggressiveness of subsequent care. While final infarct volumes have been shown to correlate with outcomes in anterior circulation strokes, no such relationship has been described in basilar artery occlusions. We sought to determine the relationship between the volume of final infarction, location of infarction and outcome of clinical course in patients treated with endovascular therapy for basilar artery occlusion at our institution. Methods: A retrospective review of our prospectively maintained endovascular stroke database identified 103 patients of which 59 patients underwent post treatment MRI. Automated software was used to measure infarct volume. Results: Patients included in the study had the following features: mean age 61, mean NIHSS 20, female 24%. Successful recanalization (TIMI 2/3) occurred in 53/59 patients (90%). Infarcts were divided into topographic regions (see Table). Good outcomes (mRS 0-2 at 3 months) were achieved in 32% of patients. 71% of patients with no brainstem infarct had a good outcome (p=0.03). 46% of patients with no thalamic infarct had a good outcome (p=0.049). In multivariate analysis, independent predictors of good outcomes were brainstem infarct volume (OR 0.25, 95% CI 0.11-0.61, p=0.002) and age (OR 0.84, CI 0.74-.91, p=0.0018). Patients with good outcomes had a mean brainstem infarct volume of 1.45 cc, while patients with poor outcomes had a mean brainstem infarct volume of 6 cc (p=0.002). Conclusions: Rate of good outcomes after recanalization of basilar artery occlusion is 32%. Presence and volume of brainstem infarct, presence of thalamic infarct and patient age are the strongest predictors of outcome. Further studies will address whether these parameters can be used prospectively in prognosticating outcomes after basilar artery occlusive disease.