Retrospective analysis of neurological outcome after intra-arterial thrombolysis in basilar artery occlusion

Glasgow Coma Scale Does Not Predict Outcome Post-Intra-Arterial Treatment for Basilar Artery Thrombosis

“…TIMI was classified as grade 0, complete occlusion or no flow/ perfusion of distal vasculature; grade 1, minimal flow/perfusion but with no opacification of distal vasculature; grade 2, partial obstruction leading to delayed opacification of distal vasculature; and grade 3, complete unimpeded perfusion of the distal vasculature regardless of whether residual stenosis was present. 16 "Recanalization" was defined as TIMI grade 2 or 3. After diagnostic angiography confirmed basilar artery thrombosis and intrathrombus placement of the microcatheter was achieved, an initial 200,000 U of urokinase with 5000 U of heparin was administered, followed by pulsed hand injections of further urokinase (maximum 1,000,000 U).…”

“…The GCS is frequently used as a selection criterion for IA treatment, with the view that high GCS is associated with better neurologic outcome. 11,16,17 However, Tsao et al, 17 who state that initial GCS predicts outcome following thrombolysis in posterior circulation stroke, had a total of 21 patients, of whom only 12 received IA therapy (9, urokinase; 3, IA tissue plasminogen activator). In addition, the patients of Tsao et al were treated without the use of mechanical thrombectomy, angioplasty, or stent insertion, so this small cohort may not be applicable to current patient cohorts with newer methods of revascularization.…”

“…In addition, the patients of Tsao et al were treated without the use of mechanical thrombectomy, angioplasty, or stent insertion, so this small cohort may not be applicable to current patient cohorts with newer methods of revascularization. Ezaki et al 16 used a GCS of 10 as an arbitrary cutoff in assessing outcome, which does not acknowledge significant clinical differences from GCS 3-9. We hypothesize that a low GCS of Յ6 does not correlate with poorer neurologic outcome after IA treatment in acute basilar thrombosis and propose that low GCS should not preclude IA treatment.…”

Time is Brain(stem) in Basilar Artery Occlusion

“…Previous studies that investigated predictors of recanalization and functional outcome after BAO often dichotomized time to treatment with a cutoff of 6 hours after symptom onset. 6,7 Some studies found no association between time to treatment and recanalization or outcome. 6,7 Others found that time to treatment was a predictor of functional outcome in univariable but not in multivariable analyses.…”

“…6,7 Some studies found no association between time to treatment and recanalization or outcome. 6,7 Others found that time to treatment was a predictor of functional outcome in univariable but not in multivariable analyses. 8 Our results imply that patients with BAO should be treated as soon as possible after symptom onset, similar to patients with ischemic stroke in the anterior circulation.…”