Abstract
Background and Purpose: The objective of this study was to identify prognostic factors of endovascular treatment in patients with acute basilar artery occlusion and add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion.Materials and Methods: We reviewed the data of 101 patients with acute basilar artery occlusion receiving endovascular treatment from January 2013 to September 2019. Baseline characteristics and outcomes were evaluated. A favourable functional outcome was defined as a mRS of 0 to 2 assessed at the 3 month follow-up. The association of clinical and procedural characteristics with the functional outcome and mortality was assessed.Results: The study population consisted of 101 patients: 83 males and 18 females. Successful recanalization was achieved in 99 patients (97.1%). A favourable clinical outcome was observed in 50 patients (49.5%), and the overall mortality rate was 26.7%. A favourable outcome was significantly associated with NIHSS score at admission and lung infection. Mortality was associated with NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, and diabetes mellitus.Conclusions: This study suggested that NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, diabetes mellitus, and lung infection can predict the functional outcome and mortality. These initial results add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion and need to be confirmed by further prospective studies.
Highlights
Acute basilar artery occlusion (ABAO) is an uncommon but potentially devastating neurological condition, accounting for ∼20% of posterior circulation strokes [1] and approximately 1% of all ischaemic strokes [2], and is associated with a very poor outcome [3]
Compared with either intravenous or intraarterial thrombolysis, systematic meta-analyses of case series and registry data have indicated that mechanical thrombectomy provides the optimal potential for improved recanalization rates and more favourable clinical outcomes in patients with BAO, but well-conducted randomised controlled trials are needed [7,8,9,10,11,12,13]
Based on two separate meta-analyses, the results from our study together with those of previous reports, showing higher recanalization rates and a better prognosis for patients with ABAO managed with endovascular thrombectomy when compared with drug therapy alone, suggest that our endovascular treatment (EVT) strategy (mechanical thrombectomy combined with intracranial angioplasty or Severe group, No (%) Symptom-onset-to-treatment time (OTT), median (IQR), min OTT ≤360 min, No (%) Puncture-to-recanalization time (PTR), median (IQR), min General anaesthesia, No (%) Number of thrombectomy device passes, median (IQR), min BA occlusion site, No (%)
Summary
Acute basilar artery occlusion (ABAO) is an uncommon but potentially devastating neurological condition, accounting for ∼20% of posterior circulation strokes [1] and approximately 1% of all ischaemic strokes [2], and is associated with a very poor outcome [3]. Compared with either intravenous or intraarterial thrombolysis, systematic meta-analyses of case series and registry data have indicated that mechanical thrombectomy provides the optimal potential for improved recanalization rates and more favourable clinical outcomes in patients with BAO, but well-conducted randomised controlled trials are needed [7,8,9,10,11,12,13]. The only large randomised controlled trial (the BASICS Study) has not shown obvious advantages of endovascular therapy over medical therapy, but too long time span, recruitment without achieving anticipated and partial presence of cross-group cases weaken the objectivity of the results [14]. Further evidence in the use of endovascular treatment (EVT) in posterior-circulation strokes is required. The objective of this study was to identify prognostic factors of endovascular treatment in patients with acute basilar artery occlusion and add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion
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