Clinical Outcomes of Patients with Acute Basilar Artery Occlusion in Brazil: An Observational Study

Dias, F.T.; Aléssio-Alves, Frederico Fernandes; Castro-Afonso, Luís Henrique de; Cougo, Pedro; Barreira, Clara M; Camilo, Millene Rodrigues; Nakiri, Guilherme Seizem; Abud, Daniel Giansante; Pontes-Neto, Octávio Marques

doi:10.1016/j.jstrokecerebrovasdis.2017.04.043

Cited by 22 publications

(21 citation statements)

References 36 publications

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“…Endovascular treatment (EVT) with mechanical thrombectomy (MT) is the gold standard therapy for anterior circulation large vessel occlusion strokes within 6 h of stroke onset [1], and it may benefit selected patients with extended time windows up to 24 h [2,3]. Basilar artery occlusion (BAO) is a rare stroke subtype with high morbidity and mortality rates [4][5][6]. Although MT improves outcomes for anterior circulation large vessel occlusion strokes, in Basilar Artery International Cooperation Study registry -the largest published cohort of BAO patients -there were no significant differences between treatment groups regarding clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Collateral Scores and Outcomes after Endovascular Treatment for Basilar Artery Occlusion

et al. 2019

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Background: Basilar artery occlusion (BAO) is a rare stroke subtype with high mortality rates. Best BAO reperfusion strategy is still controversial. Objective: We aim to describe outcomes of BAO patients submitted to mechanical thrombectomy (MT) in a comprehensive stroke center in Brazil and analyze which previous published computed tomography angiography (CTA) collateral score better predict functional outcomes. Methods: Retrospective analysis of consecutive BAO patients. CTA was used to evaluate the posterior circulation collateral score (PC-CS), the basilar artery on CTA score, and for the presence of posterior communicating arteries. A favorable outcome was defined as modified Rankin Score ≤3 at 90-days. After univariate analyses, multivariate logistic re-gression was used to identify if any collateral score independently predicts favorable outcomes. Results: Between January 2011 and April 2017, 27 (85% male) BAO patients with median NIHSS 26 (IQR 15-32) were identified. Twenty-five (93%) patients were treated with MT devices, and only 2 (7%) patients were treated with angioplasty and stenting. Successful recanalization rate was 85%, and only 1 (3.7%) patient had symptomatic hemorrhagic transformation. Favorable outcomes were reached in 10 (37%) patients. In univariate analysis, female sex, NIHSS, Glasgow coma scale, mild-to-moderate symptoms on admission, onset-to-groin time, and PC-CS predicted favorable outcomes. In multivariate analysis, PC-CS (OR 1.69; 95% CI 1.10-2.60; p = 0.016) and NIHSS (OR 0.84; 95% CI 0.77-0.93; p = 0.001) remained the only independent predictors of favorable outcomes. The PC-CS AUC was 0.80 (95% CI 0.62-0.98; p = 0.012). Conclusions: MT is a promising strategy for BAO treatment. Among collateral scores, PC-CS was the only independent predictor of favorable outcomes in the present study.

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Section: Introductionmentioning

confidence: 99%

Collateral Scores and Outcomes after Endovascular Treatment for Basilar Artery Occlusion

et al. 2019

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“…A total of 17 studies (4 on IVT and 13 on SRT) [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24] with a total of 672 patients (IVT, n = 314; SRT, n = 358) were retrieved (see Fig. 1 for data collection).…”

Section: Resultsmentioning

confidence: 99%

Stent Retriever Thrombectomy Potentially Increases the Recanalization Rate, Improves Clinical Outcome, and Decreases Mortality in Acute Basilar Occlusion: A Systematic Review and Meta-Analysis

Shen

Ravesh

Jansen

et al. 2019

Cerebrovasc Dis Extra

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Background: Acute basilar artery occlusion (BAO) is a devastating condition if untreated. The optimal treatment strategy, however, is unknown. Historically, interventional approaches have been favored over intravenous thrombolysis (IVT), although this is not supported by good evidence. The aim of this systematic review and meta-analysis was to summarize and compare the results for treatment modalities of BAO, namely, IVT and interventional stent retriever thrombectomy (SRT). Methods: Studies on IVT and SRT in BAO were systematically searched. Successful recanalization (TICI ≥2b), favorable clinical outcome (modified Rankin Scale score ≤2), mortality, and the rate of symptomatic intracranial hemorrhage (SICH) were the target parameters. Only studies with ≥15 patients were included. IVT prior to SRT was allowed. Studies were excluded (1) if >1 thrombectomy device was used in >50% of the patients and (2) when data on outcome or treatment could not be parsed (e.g. registries). Odds ratios (ORs) were calculated using Mantel-Haenszel risk ratio estimation. Results are given as OR and the 95% confidence interval (95% CI). The χ² test was used to compare the outcome parameters clinical outcome, recanalization, mortality, and SICH. Results: A total of 17 studies (4 on IVT and 13 on SRT) with a total of 672 patients (IVT, n = 314; SRT, n = 358) were identified. Cumulatively, we found a highly significantly improved clinical outcome (43 vs. 31%, p = 0.004, OR [95% CI] = 1.66 [1.21, 2.76]), increased recanalization rate (88 vs. 60%, p < 0.00001, OR [95% CI] = 3.99 [2.73, 5.84]), and decreased mortality (26 vs. 41%, p = 0.0004, OR [95% CI] = 1.86 [1.33, 2.61]), as well as an equal rate of SICH (5 vs. 7%, p = 0.15, OR [95% CI] = 1.68 [0.82, 3.43]), in patients treated with SRT compared to those treated with IVT alone. Conclusions: The data from this meta-analysis suggest a possible superiority of SRT over IVT, pending positive results of randomized controlled trials. According to international recommendations, patients with BAO should preferentially be treated with SRT; if no contraindications exist, IVT should not be withheld.

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“…Table summarizes the most recent studies on vital and functional outcomes after BAO . Only two of them reported long‐term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, 70% of survivors could walk without assistance at 1 and 5 years. Table 4 summarizes the most recent studies on vital and functional outcomes after BAO [1,[6][7][8][9]12]. Only two of them reported long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The most recent study on the natural history of patients with BAO with no reperfusion therapy showed a case fatality of 40% and a functional disability of 65% at 1 month . These outcomes have not been much improved by intravenous thrombolysis (IVT) and endovascular treatments (EVTs) . However, most data come from observational studies, which are probably contaminated by selection bias (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term mortality, disability and stroke recurrence in patients with basilar artery occlusion

Hawkes

Blaginykh

Ruff

et al. 2019

Euro J of Neurology

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Background and purpose The long‐term outcomes and stroke recurrence after basilar artery occlusion (BAO) are largely unknown. We aimed to assess these variables in a comparatively large series of consecutive patients. Methods Adults with acute BAO were retrospectively identified from 1976 to 2011. Post‐discharge records were reviewed to assess for stroke recurrences, mortality and disability. Exploratory analysis of survival was carried out using Kaplan–Meier and log‐rank tests. Factors associated with survival time were determined using Cox models. Results A total of 86 patients (34% female, median age 72 [interquartile range (IQR), 60–79] years) with a median National Institutes of Health Stroke Scale score of 11 (IQR, 6–27) were included. Twenty‐nine patients (34%) died during the initial hospitalization. Median modified Rankin Scale (mRS) score at discharge among survivors was 4 (IQR, 2.5–5.5). At 1 and 5 years, 70% of survivors ad a mRS ≤3. Seventeen patients had recurrent strokes during the hospitalization and 12 patients had 19 recurrent strokes after discharge. The median survival time was 52 days (IQR, 6–1846). Older age per decade on admission [adjusted hazard ratios (aHR), 1.32; 95% confidence interval (CI), 1.05–1.66, P = 0.02] and a higher mRS at discharge (aHR, 4.48; 95% CI, 2.72–7.39, P < 0.0001) were associated with mortality. Patients who were not treated with any reperfusion therapy had a trend towards reduced mortality (aHR, 0.39; 95% CI, 0.14–1.08, P = 0.07). Conclusions Survivors from BAO had severe short‐term functional disability. Most deaths and stroke recurrences occurred within the first year following the initial event. The risk of death was higher in older and more disabled survivors. However, favorable long‐term recovery was possible.

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Clinical Outcomes of Patients with Acute Basilar Artery Occlusion in Brazil: An Observational Study

Cited by 22 publications

References 36 publications

Collateral Scores and Outcomes after Endovascular Treatment for Basilar Artery Occlusion

Collateral Scores and Outcomes after Endovascular Treatment for Basilar Artery Occlusion

Stent Retriever Thrombectomy Potentially Increases the Recanalization Rate, Improves Clinical Outcome, and Decreases Mortality in Acute Basilar Occlusion: A Systematic Review and Meta-Analysis

Long‐term mortality, disability and stroke recurrence in patients with basilar artery occlusion

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