Abstract
Acute ischemic stroke due to basilar artery occlusion (BAO) carries a very poor prognosis. Functional outcomes in BAO patients undergoing endovascular therapy (EVT) may differ according to the specific pathological mechanisms. We aimed to explore the impact of the underlying pathological mechanisms on prognosis at 90-days and long-term follow-up in BAO patients treated with EVT. We analyzed consecutive BAO patients undergoing EVT from December 2012 to December 2018 at a single center (Xuanwu Hospital). Patients were classified into either an intracranial atherosclerotic disease (ICAD) group or an embolic group according to the corresponding angiographic findings. The baseline characteristics and functional outcomes were compared between the two groups. Multivariable logistic regression analysis was performed. Among the 167 patients enrolled, 78 patients (46.7%) were in the ICAD group and 89 patients (53.3%) were assigned to the embolic group. Overall, 149 patients (89.2%) achieved successful reperfusion post-EVT. There were no significant differences in functional outcomes at 90-days and long-term follow-up between the two groups. Similarly, a Kaplan-Meier survival analysis showed similar long-term survival probabilities (P = 0.438). The pathological mechanism was not associated with functional independence (OR, 1.818; 95% CI, 0.694-4.761; P = 0.224), favorable outcome (OR, 1.476; 95% CI, 0.592-3.681; P = 0.403), or mortality (OR, 1.249; 95% CI, 0.483-3.226; P = 0.646). However, based on subgroup analysis, embolic BAO versus ICAD was significantly associated with better functional independence in those aged 60 years and younger (OR, 4.513; 95% CI, 1.138-17.902). In this study, no differences in either 90-days or long-term functional outcomes between ICAD-related BAO and embolic BAO patients undergoing EVT were observed. However, in BAO patients aged ≤ 60 years, the pathological mechanism of embolism was associated with better functional independence.
Highlights
Acute ischemic stroke due to basilar artery occlusion a very poor prognosis, carrying a morbidity and mortality (BAO) accounts for approximately 1% of all ischemic rate of over 80% [3,4,5]
We aimed to explore the impact of the underlying pathological mechanisms on prognosis at 90-days and long-term follow-up in BAO patients treated with Endovascular therapy (EVT)
The eligibility criteria were as follows: 1) acute ischemic stroke secondary to acute BAO or bilateral vertebral artery V4 segment occlusion leading to no blood flow to the basilar artery, as identified by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA); 2) EVT was initiated within 24 hours of stroke onset; 3) patients needed a score of least 6 on the National Institutes of Health Stroke Scale (NIHSS) at baseline; and 4) patients were required to have a pre-morbid functional ability of 2 or less on the modified Rankin scale
Summary
Acute ischemic stroke due to basilar artery occlusion a very poor prognosis, carrying a morbidity and mortality (BAO) accounts for approximately 1% of all ischemic rate of over 80% [3,4,5]. We aimed to explore the impact of the underlying pathological mechanisms on prognosis at 90-days and long-term follow-up in BAO patients treated with EVT. The eligibility criteria were as follows: 1) acute ischemic stroke secondary to acute BAO or bilateral vertebral artery V4 segment occlusion leading to no blood flow to the basilar artery, as identified by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA); 2) EVT was initiated (groin puncture) within 24 hours of stroke onset (or last known normal time); 3) patients needed a score of least 6 on the National Institutes of Health Stroke Scale (NIHSS) at baseline; and 4) patients were required to have a pre-morbid functional ability of 2 or less on the modified Rankin scale (mRS). The exclusion criteria included: 1) evidence of a large ischemic core as indicated by the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS) of less than 6; 2) patients with a stroke in the distribution of the anterior circulation or a posterior cerebral artery occlusion; 3) occlusion resulting from other causes including vascular dissection, vasculitis, or Moyamoya disease; 4) patients with an indistinguishable pathological mechanism because reperfusion was never observed; or 5) patients who were lost to follow-up
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