Abstract
Background and Purpose: Decision algorithms for large vessel occlusions in the anterior circulation remain unconfirmed for acute basilar artery occlusion (aBAO). The aim of this study was to investigate procedural parameters, patient characteristics, functional outcome, and survival in dependency of the time window to recanalization from symptom onset. Furthermore predictors of outcome were identified.Materials and Methods: Retrospectively 231 patients with aBAO treated with endovascular treatment (EVT) between November 2008 and February 2019 were identified in a prospectively maintained single center stroke database. Baseline characteristics such as age, cardiovascular risk factors, NIHSS at admission, pre-interventional PC-ASPECTS, periprocedural parameters such as time to recanalization, duration of treatment, extent of reperfusion, collateral status, and occlusion patterns, as well as post-interventional 24 h NIHSS and post-interventional ICH were evaluated. Target variables were mRS at 90 days and mortality over 90 days.Results: Good outcome (mRS 0–2) was attained in 29.5% (n = 68) of patients, overall mortality was 36.8% (n = 85). In mulitivariate analyses patients with time to reperfusion beyond 6 h had a more than half fold decreased chance of good outcome [OR 0.47 95% CI (0.23–0.95) p < 0.05]. The odds for good outcome were reduced by almost 2/3 if post-interventional imaging revealed intracerebral hemorrhage [OR 0.28 95% CI (0.08–0.98)]. Unfavorable outcome was noted in 100% (n = 14) of patients with symptomatic ICH. Risk for death was reduced by more than 80% if collaterals were present [0.16 95% CI (0.03–0.87)] and if recanalization was successful (TICI 2b-3) [OR 0.19 95% CI (0.05–0.78)]. The odds for survival were 5-fold higher in patients with no post-interventional hemorrhages present [OR 5.35 95% CI (2.2–1.58)].Conclusion: This study might contribute to explaining the ambiguous findings regarding the validity of the 6 h time window in aBAO, suggesting that collateral status impacts the odds of survival in the time window to recanalization beyond 6 h. In our study recanalization within 6 h from symptom onset was associated with good outcome. Successful recanalization (TICI 2b-3a) was necessary for good outcome and survival, post-interventional ICH was highly associated with unfavorable outcome. This might ease the decision making for EVT.
Highlights
The overwhelmingly positive trial results favoring mechanical thrombectomy over thrombolysis have represented one of the most important advances in stroke care for decades
Despite methodological limitations, successful recanalization in Acute basilar artery occlusion (aBAO) is endorsed as a key factor for survival and functional outcome [8,9,10] as recently reported in a study with 51 patients, IV thrombolysis alone failed to achieve recanalization in thrombi exceeding a length of 13 mm in aBAO [11]
We retrospectively identified all consecutive patients in our prospectively maintained single center stroke database who had undergone endovascular treatment (EVT) for an aBAO between November 2008 and February 2019
Summary
The overwhelmingly positive trial results favoring mechanical thrombectomy over thrombolysis have represented one of the most important advances in stroke care for decades. The positive trials all enrolled patients with anterior circulation strokes and the advantage of mechanical thrombectomy in large vessel thromboembolic occlusion in the posterior circulation is yet to be determined. Acute basilar artery occlusion (aBAO) is one of the most devastating subtypes of stroke with a mortality rate of more than 30% following mechanical thrombectomy (mTE) [1, 2]. Procedural parameters and patient characteristics including collateral status and pathophysiological properties such as occlusion patterns were assessed and stratified by time to recanalization\reperfusion (TICI 2b-3) (TTR) from symptom onset. Functional outcome and survival after 90 days were studied, stratified by the time window to treatment. The aim of this study was to investigate procedural parameters, patient characteristics, functional outcome, and survival in dependency of the time window to recanalization from symptom onset.
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