Acute Basilar Artery Occlusion Patients Research Articles

Outcome of endovascular treatment for acute basilar artery occlusion in the modern era: a single institution experience.

The beneficial effect of endovascular treatment (EVT) for patients with acute basilar artery occlusion (ABAO) remains uncertain. The purpose of the present study was to evaluate clinical outcome of EVT for patients with ABAO and analyze prognostic factors of good outcome. From our prospectively established database, we reviewed all patients with ABAO receiving EVT during January 2014 to December 2016. Baseline characteristics and outcomes were evaluated. Favorable functional outcome was defined as modified Rankin Scale score of 0 to 3 assessed at 3-month follow-up. The association between clinical and procedural characteristics and functional outcome was assessed. Of the 68 patients included, 50 patients (73.5%) received mechanical thrombectomy with stent retriever device. Successful reperfusion (thrombolysis in cerebral infarction grades 2b-3) was achieved in 61 patients (89.7%). Overall favorable functional outcome was reached by 31 patients (45.6%). In univariate analysis, Glasgow Coma Scale sum score, baseline National Institutes of Health stroke scale score (NIHSS), and baseline glycemia level were identified predicting good clinical outcome. Multivariate analysis showed that lower NIHSS was the only independent risk factor of favorable functional outcome (OR 0.832; 95% CI, 0.715-0.968; p = 0.018). No difference of favorable outcomes was observed between the subgroups of time to EVT < 6h and ≽6h. Data in the present study suggests that EVT for ABAO patients should be reasonable within 24h of symptom onset. The most important factor determining clinical outcome is initial stroke severity.

Abstract WP22: Collateral Score and Outcome After Endovascular Treatment for Basilar Occlusion

Introduction: Basilar artery occlusion (BAO) is a rare stroke subtype with high morbidity and mortality rates. Best reperfusion strategy is still somewhat controversial and is currently under investigation in multicenter randomized trials. We aim to describe outcomes of BAO patients submitted to mechanical thrombectomy in a comprehensive stroke center in Brazil and analyze which previous published computed tomography angiography (CTA) collateral score better predicts functional outcomes. Methods: Retrospective analysis of consecutive BAO patients from a prospective stroke registry. BAO was diagnosed through CTAs, which were also used to evaluate the Posterior Circulation Collateral Score (PC-CS), the Basilar Artery on Computed Tomography Angiography (BATMAN) scores and also for the presence of both posterior communicating arteries. A favorable outcome was defined as a mRS ≤3 at 90 days. After univariate analyses, multivariate logistic regression was used to identify if any collateral score independently predicts a favorable outcome. We also used ROC curves and C-statistics for score comparisons. Results: Between January/2011 and April/2017, 27 (85% male) BAO patients with median NIHSS of 26 (IQR:15-32) were identified. Twenty-five (93%) patients were treated with a stent-retriever or an aspiration device, and only 2 (7%) patients were treated with basilar artery angioplasty and stenting. Recanalization rate was 85% and only 1 (3.7%) patient had a symptomatic hemorrhagic transformation. Favorable outcomes were reached in 10 (37%) patients at 90-days and mortality rate was 37%. In univariate analysis, female sex, NIHSS, onset-to-groin time and PC-CS predict favorable outcomes. In multivariate analysis, only PC-CS (OR=1.69;95%CI:1.10-2.60;p=0.016) and the baseline NIHSS (OR=0.84;95%CI:0.77-0.93;p=0.001) remained as independent predictors of favorable outcomes. The PC-CS AUC for favorable outcome was 0.80 (95%CI:0.62-0.98;p=0.012). Conclusions: Mechanical thrombectomy seems to be a promising strategy for patients with acute BAO. Collateral flow assessment using the PC-CS is an independent predictor of favorable outcomes among acute BAO patients treated with mechanical thrombectomy.

Endovascular Mechanical Thrombectomy with the Solitaire Device for the Treatment of Acute Basilar Artery Occlusion

To determine the safety and efficacy of endovascular treatment with the Solitaire device for acute basilar artery occlusion (ABAO) and identify factors affecting clinical outcomes. We enrolled 36 consecutive ABAO patients (aged 58.6 ± 8.10 years) who underwent mechanical thrombectomy with the Solitaire device. We analyzed baseline characteristics, mechanical thrombectomy results, and factors predicting clinical outcomes, which were assessed at 90 days. The median prethrombectomy National Institutes of Health Stroke Scale (NIHSS) score was 25.50 (interquartile range: 21.00-29.00); the median prethrombectomy Glasgow Coma Scale (GCS) score was 8.00 (5.00-9.75). Thirty patients (83.3%) had atherosclerotic stenosis of the occluded artery, and 25 underwent angioplasty (69.4%). Recanalization was successful (Thrombolysis in Cerebral Infarction grade: 2b-3) in 34 patients (94.4%). Six symptomatic intracranial hemorrhages (16.67%) occurred. Favorable outcomes (modified Rankin scale [mRS] score: 0-2) were achieved in 27.8% patients (10/36). The overall mortality rate was 30.6% (11/36) at 90 days. On univariate analysis, low prethrombectomy GCS and high post-thrombectomy NIHSS scores were associated with poor outcomes (mRS score >2) and mortality. Prethrombectomy unconsciousness, onset-to-recanalization time > 10.5 hours, and severe stenosis were associated with poor outcomes. Age ≥ 60 years was associated with mortality. Endovascular treatment with the Solitaire device yielded high recanalization rates in ABAO patients and favorable clinical outcomes in approximately one third of patients. Intracranial stenosis was the main cause of occlusion. Angioplasty was commonly performed during mechanical thrombectomy to improve recanalization and prognosis. Early recanalization and better prethrombectomy status predicted better outcomes.

Diffusion weighted imaging reversibility in the brainstem following successful recanalization of acute basilar artery occlusion

Acute basilar artery occlusion (ABAO) is a devastating disease that can produce significant brainstem injury. Pretreatment diffusion weighted imaging (DWI) demonstrating extensive brainstem involvement has been shown to predict a...

MULTIMODAL REPERFUSION THERAPY IN PATIENTS WITH ACUTE BASILAR ARTERY OCCLUSION

Multimodal reperfusion therapy (MMRT) has been advocated for the treatment of acute basilar artery occlusion (ABAO). We aimed to identify prognostic factors in patients with ABAO who underwent MMRT. Clinical and radiological data from consecutive ABAO patients were analyzed. All patients underwent MMRT on an emergency basis. Stroke subtypes were categorized according to TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Good outcome was defined as a modified Rankin Scale score of 3 or less and poor outcome as a score of 4 or more at 30 days poststroke. Twenty-four patients were included (18 men, 6 women) with a mean age of 54.7 years (age range, 26-70 years). Six patients died (25%), and 8 of the surviving 18 patients (44%) achieved a modified Rankin Scale score of 3 or less at 30 days. We could not identify any clinical or radiological variables that were associated with a greater likelihood of good or poor outcome at 30 days other than the presence of good collateral circulation, which was associated with better outcome on univariate analysis. MMRT resulted in high survival and good outcome rates. We could not identify prognostic factors in patients with ABAO treated with MMRT other than the presence of collateral flow. Our results imply that patients should not be excluded from treatment based on clinical or radiological parameters, and that all patients with ABAO should be given the chance to benefit from therapy.