Shorter time to intervention improves recanalization success and clinical outcome post intra-arterial intervention for basilar artery thrombosis

Abstract

Basilar artery thrombosis is associated with poor clinical outcomes and high mortality rate if untreated. Clinical outcome correlates with recanalization success. As arterial clot composition undergoes organization over time and may become more resistant to recanalization therapy, we postulate that recanalization success is time-dependent. We aim to investigate whether time to intervention predicts recanalization success leading to improved clinical outcomes. Forty-nine consecutive patients with basilar artery thrombosis treated with intra-arterial (IA) therapy between 1993 and 2011 were included. Patient demographics, clinical features, clot location, time to intervention and post-procedural thrombolysis in myocardial infarction (TIMI) scores were collected. Recanalization success was defined as a score of TIMI 2–3. Clinical outcome was measured using the 90-day modified Rankin Scale (mRS) score, with good neurological outcome defined as mRS 0–2. The mean patient age was 59.8years±17.9 and 36.7% were females. IA therapy was commenced within 6hours of stroke onset in 17/49 (34.7%) patients. Of this 6-hour onset group, 17/17 (100%) demonstrated recanalization success (TIMI 2–3) and 10/17 (58.8%) achieved good neurological outcome at 90-days. IA therapy was commenced after 6hours of stroke onset in 32/49 (65.3%) patients, with 24/32 (75%) and 6/32 (18.75%) patients achieving recanalization success and good outcome, respectively. A shorter delay to IA therapy is significantly associated with recanalization success (p=0.038) and good neurological outcome at 90days (p=0.009) in patients with acute basilar artery thrombosis. We recommend a systematic approach to minimize time delay to IA therapy for this condition.