Outcome Predictors in Acute Basilar Artery Occlusion

Abstract

368Basilar artery occlusion (Bao) is an infrequent form of acute ischemic stroke (aiS). this particular type of stroke occurs in approximately 1% of all-cause cases and is reported in approximately 8% of patients with symptomatic vertebrobasilar territory ischemia.1,2 Basilar artery occlusion symptoms are heterogeneous and may vary from mild neurological deficits consisting of visual, oculomotor, and behavioral abnormalities to a locked-in state or coma.3,4 however, severe and persistent ABSTRACT: Objective: to identify predictors of good outcome in acute basilar artery occlusion (Bao). Background: acute ischemic stroke (aiS) caused by Bao is often associated with a severe and persistent neurological deficit and a high mortality rate. Methods: the set consisted of 70 consecutive aiS patients (51 males; mean age 64.5±14.5 years) with Bao. the role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30-and 90-day outcome was assessed using the modified rankin scale with a good outcome defined as a score of 0-3. Results: the following statistically significant differences were found between patients with good versus poor outcomes: mean age (54 RÉSUMÉ: Facteurs de prédiction du résultat dans l'occlusion aiguë de l'artère basilaire. Objectif : le but de l'étude était d'identifier les facteurs de prédiction d'une issue favorable dans l'occlusion aiguë de l'artère basilaire (oaB). Contexte : l'accident vasculaire cérébral ischémique aigu (aVCia) causé par une oaB est souvent associé à un déficit neurologique sévère et persistant et à un taux de mortalité élevé. Méthodes : l'étude a porté sur 70 patients consécutifs atteints d'une oaB, dont 51 étaient des hommes et dont l'âge moyen était de 64,5 ± 14,5 ans. nous avons étudié le rôle des facteurs suivants : les caractéristiques des patients à l'évaluation initiale, les facteurs de risque d'un aVC, le traitement antithrombotique avant l'oaB, le déficit neurologique au moment du traitement, le temps écoulé entre le début des symptômes et le début du traitement, le mode de traitement, le taux de recanalisation, les changements constatés concernant le déficit neurologique, les constatations à l'imagerie après le traitement. nous avons évalué les résultats à deux reprises, soit 30 jours et 90 jours après l'événement, au moyen de l'échelle modifiée de rankin, une issue favorable étant définie comme un score de 0 à 3. Résultats : les différences suivantes étaient significatives au point de vue statistique entre les patients dont l'issue était bonne par rapport à ceux dont l'issue était médiocre : l'âge moyen des patients (54,2 vs. 68,9 ans ; p = 0,0001), la présence d'hypertension artérielle (52,4% vs. 83,7% ; p = 0,015), de diabète (9,5% vs. 55,1% ; p = 0,0004) et d'un aVC sévère (14,3% vs. 65,3%; p = 0,0002), le déf...

Predictors of Good Clinical Outcome in Patients with Acute Stroke Undergoing Endovascular Treatment – Results from CERBERUS

“…These findings are consistent with our previous study in posterior-circulation strokes due to BA occlusion; higher NIHSS at the time of treatment, longer time to treatment and arterial hypertension were identified as independent negative predictors of favorable clinical outcome [17]. Likewise, the ASPECT score [18], older age, stroke severity and a history of diabetes mel litus were identified as negative predictors of good clinical outcome in posterior-circulation strokes [19].…”

Posterior vs. Anterior Circulation Infarction: Demography, Outcomes, and Frequency of Hemorrhage after Thrombolysis

“…To the best of our knowledge, this is the largest single-center series assessing the safety and clinical outcome of IVT for PCS. Most of the previously published studies evaluating the safety and efficacy of IVT for PCS had small sample sizes (range, 9–84 patients), they assessed ICH using a different definition of SICH, or they investigated acute basilar artery occlusion only (1,12–17).…”

“…To the best of our knowledge, this is the largest single-center series assessing the safety and clinical outcome of IVT for PCS. Most of the previously published studies evaluating the safety and efficacy of IVT for PCS had small sample sizes (range, 9-84 patients), they assessed ICH using a different definition of SICH, or they investigated acute basilar artery occlusion only (1,(12)(13)(14)(15)(16)(17). The rate of PCS among IVT-treated patients (12•8% in the present study) is lower than that reported in the non-IVT population (20-26%) (18,19), which may have several reasons: Initial symptoms such as vertigo or diplopia are misinterpreted or even neglected by the patients, prolonging time to treatment and possibly excluding patients from IVT therapy.…”

Intravenous Thrombolysis in Posterior Circulation Stroke

“…Thus, additional endovascular treatment should be started as soon as possible and not considered only as a rescue strategy (57, 58). Data from two small series on basilar artery occlusion patients (52, respectively 70 patients) reported better 90-day clinical outcomes in patients treated with bridging (59, 60).…”