Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study

Abstract

Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.

Age and discharge modified Rankin score are associated with 90-Day functional outcome after basilar artery occlusion treated with endovascular therapy

“…Additionally, age was found to be an important prognostic factor in studies which included BAO patients treated with different modalities, including antiplatelets, anticoagulation, or both; 28 alteplase and full-dose heparin; 5 or EVT þ/À alteplase. 29 This suggests that age is a common and important prognostic factor for patients with BAO, irrespective of treatment modality, and our results support this to also be true for patients treated with modern EVT. Older age predisposes to atherosclerotic risk and has been linked to poor collateral status in a series of patients with anterior circulation LAO.…”

“…Our series included 9 patients with mid-basilar occlusions, with 90-day outcome data available for 8, none of whom achieved good outcome. While BAO site seems to be an important consideration, other pre-and peri-procedural factors have been reported to influence outcome, such as age, 29 NIHSS, 2,[15][16][17]21 and time to reperfusion, 3,21 as discussed. Given these factors, as well as the small sample of mid-BAO patients in our series, we do not believe that BAO site in isolation should determine EVT candidacy.…”

The Effect of Clinical and Radiological Features on Prognosis in the Top of The Basilar Syndrome

“…Fracalanza et al reported that low NIHHS score of patients with basilar artery occlusion were associated with good clinical outcome. 17 Th e mortality rate of this study was 29.6%. 17 Mortality of patients with TOBS was 8% in a study.…”

“…17 Th e mortality rate of this study was 29.6%. 17 Mortality of patients with TOBS was 8% in a study. 13 In our study, high mortality rate was detected (32.3%).…”

Postpartum Acute Basilar Artery Occlusion Secondary to Vertebral Artery Dissection. Case Report and Literature Review

“…The achievement of a good clinical outcome depends upon the timing of recanalization. Because of the high risk of a poor outcome, endovascular treatment can be attempted beyond six hours, up to a maximum of 12 to 14 hours from the onset of symptoms [ 38 ]. Recanalization of acute BAO is associated with a two-fold reduction in mortality and a 1.5-fold reduction in death or dependency [ 39 ].…”