Outcomes of basilar artery occlusion in patients aged 75 years or older in the Basilar Artery International Cooperation Study

Abstract

Patients with an acute basilar artery occlusion (BAO) have a high risk of long-lasting disability and death. Only limited data are available on functional outcome in elderly patients with BAO. Using data from the Basilar Artery International Cooperation Study, we aimed to determine outcomes in patients ≥75 years. Primary outcome measure was poor functional outcome (modified Rankin scale score 4–6). Secondary outcomes were death, insufficient vessel recanalization (defined as thrombolysis in myocardial infarction score 0–1) and symptomatic intracranial hemorrhage (SICH). Patients were divided into four age-groups, based on quartiles: 18–54, 55–64, 65–74, and ≥75 years. Outcomes were compared between patients ≥75 years and patients aged 18–54 years. Risk ratios with corresponding 95 % confidence intervals (CI) were calculated and Poisson regression analyses were performed to calculate adjusted risk ratios (aRR). We included 619 patients [18–54 years n = 153 (25 %), 55–64 years n = 133 (21 %), 65–74 years n = 171 (28 %), and ≥75 years n = 162 (26 %)]. Compared with patients aged 18–54 years, patients ≥75 years were at increased risk of poor functional outcome [aRR 1.33 (1.14–1.55)] and death [aRR 2.47 (1.75–3.51)]. Nevertheless, 35/162 (22 %, 95 % CI 15–28 %) of patients ≥75 years had good functional outcome. No significant differences between age groups were observed for recanalization rate and incidence of SICH. Although patients ≥75 years with BAO have an increased risk of poor outcome compared with younger patients, a substantial group of patients ≥75 years survives with a good functional outcome.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-012-6498-2) contains supplementary material, which is available to authorized users.

Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion

“…The predictive value of the NIHSS score for the presence of artery occlusion was suggested to be poorer in the posterior circulation than in the anterior circulation , and the cut‐off value for baseline NIHSS for favourable outcome was found to be lower in posterior circulation than in anterior circulation strokes . Last but not least, in line with the BASICS registry showing no effect of age >75 years on the incidence of sICH age was not found to be an independent risk factor either .…”

Endovascular intervention for basilar artery occlusion in the elderly

“…Third, the time from onset to treatment, an important prognostic factor for the elderly patients in our study, tended to be shorter than that in patients ⩾75 years of age with symptom onset within 24 h in the BASICS registry. 22 We compared the number and proportion of patients during five time periods stratified by time to treatment between the elderly patients in the BASICS and BASILAR registries: <3 h: 50 (34.7%) versus 91 (50.0%); 4–6 h: 50 (34.7%) versus 59 (32.4%); 7–9 h: 17 (11.8%) versus 16 (8.8%); 10–12 h: 13 (9.0%) versus 9 (4.9%); 13–24 h: 14 (9.7%) versus 7 (3.8%). And the difference was significant ( p = 0.022).…”

Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review

“…This finding may probably be explained by differences in admission characteristics of the patients 33 34. In fact, severe neurological condition on admission, with reduced consciousness and already permanent brain tissue damage, may lessen the benefits of recanalisation and hamper prognosis.…”

“…In fact, severe neurological condition on admission, with reduced consciousness and already permanent brain tissue damage, may lessen the benefits of recanalisation and hamper prognosis. It was demonstrated that poor 1-month outcome after BAO can be reliably predicted by older age, absence of hyperlipidaemia, presence of prodromal minor stroke, higher NIHSS score and longer time to treatment 34. Two main criteria that seemed to impact directly on clinical outcomes were (1) baseline ischaemic imaging lesions; and (2) time to recanalisation.…”

“…The frequency of recanalisation could partly explain the relatively low mortality of patients with BAO treated with stent retrievers. In fact, the majority of patients with no or minimal recanalisation died after intravenous rt-PA or endovascular approach 1 6 28–30 34. In addition, stent retrievers achieved faster recanalisation, whereas a time-dependent relationship was reported between time to recanalisation therapy and risk of death 38.…”