Abstract
PurposeWe present the first nationwide study on endovascular therapy for basilar artery occlusion (BAO) from early hospital management to 3-month outcome.MethodsData were collected on all acute ischaemic stroke patients registered 2016–2019 in the two national quality registers for stroke care and endovascular therapy (EVT), receiving EVT for BAO and subclassified into proximal, middle and distal.ResultsIn all, 251 patients were included: 69 proximal, 73 middle and 109 distal BAO. Patients with proximal BAO were younger (66, middle 71, distal 76, p < 0.0001), less often female (27.5%, middle 47.9%, distal 47.7%, p = 0.015), more often smokers (28.6%, middle 20.3%, distal 11.5%, p < 0.0001), and fewer had atrial fibrillation (13.2%, middle 24.7%, distal 48.6%, p < 0.0001). Level of consciousness and NIHSS score did not differ by BAO subtype and 52.2% were alert on admission. Time from groin puncture to revascularization was significantly longer in patients with proximal BAO (71, middle 46, distal 42 min, p < 0.0001), and angioplasty and/or stenting was more often performed in patients with proximal (43.4%) and middle (27.4%) than distal (6.4%) BAO (p < 0.0001). Cumulative 90-day mortality was 38.6% (proximal 50.7%, middle 32.9%, distal 34.9%, p = 0.02). Older and pre-stroke dependent patients had higher mortality, as did patients in whom angioplasty/stenting was performed.ConclusionWe confirm a serious outcome in BAO despite endovascular therapies, and demonstrate important differences relating to occlusion location in baseline characteristics, procedural time, therapeutic measures and outcome. Further in-depth analyses of factors affecting outcome in BAO are warranted.
Highlights
Ischaemic stroke caused by large vessel occlusion (LVO) in the vertebrobasilar arteries is a rare, but devastating, and often fatal subtype of occlusive cerebrovascular disease
randomized clinical trials (RCTs) for basilar artery occlusion (BAO) have been questioned in part on the grounds that they may result in treatment being withheld from patients who could potentially benefit, for being vulnerable to selection bias, and that the principles of endovascular therapy (EVT) benefit have already been proven in RCTs in the anterior circulation [30]
Combining data from two prospective registries with nationwide coverage, the present study aims to provide a comprehensive description of clinical characteristics, stroke workflow, treatment and outcome in patients receiving EVT for BAO, with stratification by lesion location
Summary
Ischaemic stroke caused by large vessel occlusion (LVO) in the vertebrobasilar arteries is a rare, but devastating, and often fatal subtype of occlusive cerebrovascular disease. Only a handful of registry studies [12,13,14,15], single- [16,17,18,19,20,21,22,23] and multicentre studies [24, 25], metaanalysis [26] and randomized clinical trials (RCTs) [27, 28] have been published on endovascular treatment benefits and outcome in patients with BAO. RCTs for BAO have been questioned in part on the grounds that they may result in treatment being withheld from patients who could potentially benefit, for being vulnerable to selection bias, and that the principles of EVT benefit have already been proven in RCTs in the anterior circulation [30]. Despite the limited RCT data, Swedish [32], European [33] and American [34] stroke guidelines recommend EVT in selected patients with BAO
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