Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion

Abstract

Our study showed a lower rate of sICH and a shift towards improved outcome in thrombolysed patients with BAO treated with LMWH as compared with UFH.

Outcomes of acute basilar artery occlusion—real‐world experience in a middle‐income country

“…Rates of unfavorable outcomes and death were high in this series of patients with BAO, in line with those described in high‐income countries 2,27,28 . Rates of ICH were also consistent with previous reports 1,5,27 . Most ICHs were asymptomatic, including hemorrhages in subjects treated with anticoagulation less than 24 h after IVT.…”

“…The type of anticoagulation treatment may also impact outcomes and the risk of ICH after BAO. Ritvonen et al 5 observed that, after the institutional protocol of IVT + UH was changed to IVT + enoxaparin, no new cases of ICH were described and better functional outcomes were achieved in patients with BAO 5 . In our series, ICH in patients treated with anticoagulation only occurred in patients treated with UH ( n = 3/20 15%).…”

Outcomes of acute basilar artery occlusion—real‐world experience in a middle‐income country

“…Rates of unfavorable outcomes and death were high in this series of patients with BAO, in line with those described in high‐income countries 2,27,28 . Rates of ICH were also consistent with previous reports 1,5,27 . Most ICHs were asymptomatic, including hemorrhages in subjects treated with anticoagulation less than 24 h after IVT.…”

“…The type of anticoagulation treatment may also impact outcomes and the risk of ICH after BAO. Ritvonen et al 5 observed that, after the institutional protocol of IVT + UH was changed to IVT + enoxaparin, no new cases of ICH were described and better functional outcomes were achieved in patients with BAO 5 . In our series, ICH in patients treated with anticoagulation only occurred in patients treated with UH ( n = 3/20 15%).…”

Comatose With Basilar Artery Occlusion: Still Odds of Favorable Outcome With Recanalization Therapy

“…The rates of 35 and 45% of good (mRS 0–2) and favorable outcomes (mRS 0–3), respectively, among the whole BAO cohort ( Table 3 ) are in line with or slightly better than in previous cohorts ( 10 , 12 , 14 , 18 , 27 – 30 ). Poorer outcomes were significantly more frequent in comatose patients ( Table 3 ).…”

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

“…The primary causes of death among the 3-month survivors were increasingly due to cardiac or vascular disorders besides the sequelae of ischemic stroke ( Limitations of the present study include the relatively small sample size in our long-term analysis and the absence of data from EVT-treated patients, for whom long-term follow-up is not yet available. Strengths of the present study include a longer follow-up time than has ever been described and a previously well-established and prospectively collected single-center IVT-treated BAO cohort [14,18,24,32] In summary, our results show a major potential benefit of prompt BAO recanalization treatment and relative longevity beyond the acute phase of the first 3 months. In the surviving patients, mortality due to non-stroke-related causes increases in relation to stroke sequelae.…”

“…Jung et al [15]reported a similar trend towards improved outcome between earlier and later time periods with rates of moderate outcome (mRS 0-3) of 35% and 53% in 1992-2003 and 2004-2010, respectively. As previously discussed, [32] this likely reflects more rapid diagnostics, prompt treatment decisions and better patient selection for recanalization treatments in recent years (Table S1). Indeed, a remarkably decreasing rate of patients treated despite baseline EIC (pc-ASPECTS < 8)…”

Outcomes of acute basilar artery occlusion—real‐world experience in a middle‐income country

“…Rates of unfavorable outcomes and death were high in this series of patients with BAO, in line with those described in high‐income countries 2,27,28 . Rates of ICH were also consistent with previous reports 1,5,27 . Most ICHs were asymptomatic, including hemorrhages in subjects treated with anticoagulation less than 24 h after IVT.…”

“…The type of anticoagulation treatment may also impact outcomes and the risk of ICH after BAO. Ritvonen et al 5 observed that, after the institutional protocol of IVT + UH was changed to IVT + enoxaparin, no new cases of ICH were described and better functional outcomes were achieved in patients with BAO 5 . In our series, ICH in patients treated with anticoagulation only occurred in patients treated with UH ( n = 3/20 15%).…”

Comatose With Basilar Artery Occlusion: Still Odds of Favorable Outcome With Recanalization Therapy

“…The rates of 35 and 45% of good (mRS 0–2) and favorable outcomes (mRS 0–3), respectively, among the whole BAO cohort ( Table 3 ) are in line with or slightly better than in previous cohorts ( 10 , 12 , 14 , 18 , 27 – 30 ). Poorer outcomes were significantly more frequent in comatose patients ( Table 3 ).…”

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

“…The primary causes of death among the 3-month survivors were increasingly due to cardiac or vascular disorders besides the sequelae of ischemic stroke ( Limitations of the present study include the relatively small sample size in our long-term analysis and the absence of data from EVT-treated patients, for whom long-term follow-up is not yet available. Strengths of the present study include a longer follow-up time than has ever been described and a previously well-established and prospectively collected single-center IVT-treated BAO cohort [14,18,24,32] In summary, our results show a major potential benefit of prompt BAO recanalization treatment and relative longevity beyond the acute phase of the first 3 months. In the surviving patients, mortality due to non-stroke-related causes increases in relation to stroke sequelae.…”

“…Jung et al [15]reported a similar trend towards improved outcome between earlier and later time periods with rates of moderate outcome (mRS 0-3) of 35% and 53% in 1992-2003 and 2004-2010, respectively. As previously discussed, [32] this likely reflects more rapid diagnostics, prompt treatment decisions and better patient selection for recanalization treatments in recent years (Table S1). Indeed, a remarkably decreasing rate of patients treated despite baseline EIC (pc-ASPECTS < 8)…”

Outcomes of acute basilar artery occlusion—real‐world experience in a middle‐income country

“…Rates of unfavorable outcomes and death were high in this series of patients with BAO, in line with those described in high‐income countries 2,27,28 . Rates of ICH were also consistent with previous reports 1,5,27 . Most ICHs were asymptomatic, including hemorrhages in subjects treated with anticoagulation less than 24 h after IVT.…”

“…The type of anticoagulation treatment may also impact outcomes and the risk of ICH after BAO. Ritvonen et al 5 observed that, after the institutional protocol of IVT + UH was changed to IVT + enoxaparin, no new cases of ICH were described and better functional outcomes were achieved in patients with BAO 5 . In our series, ICH in patients treated with anticoagulation only occurred in patients treated with UH ( n = 3/20 15%).…”

Comatose With Basilar Artery Occlusion: Still Odds of Favorable Outcome With Recanalization Therapy

“…The rates of 35 and 45% of good (mRS 0–2) and favorable outcomes (mRS 0–3), respectively, among the whole BAO cohort ( Table 3 ) are in line with or slightly better than in previous cohorts ( 10 , 12 , 14 , 18 , 27 – 30 ). Poorer outcomes were significantly more frequent in comatose patients ( Table 3 ).…”

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

“…The primary causes of death among the 3-month survivors were increasingly due to cardiac or vascular disorders besides the sequelae of ischemic stroke ( Limitations of the present study include the relatively small sample size in our long-term analysis and the absence of data from EVT-treated patients, for whom long-term follow-up is not yet available. Strengths of the present study include a longer follow-up time than has ever been described and a previously well-established and prospectively collected single-center IVT-treated BAO cohort [14,18,24,32] In summary, our results show a major potential benefit of prompt BAO recanalization treatment and relative longevity beyond the acute phase of the first 3 months. In the surviving patients, mortality due to non-stroke-related causes increases in relation to stroke sequelae.…”

“…Jung et al [15]reported a similar trend towards improved outcome between earlier and later time periods with rates of moderate outcome (mRS 0-3) of 35% and 53% in 1992-2003 and 2004-2010, respectively. As previously discussed, [32] this likely reflects more rapid diagnostics, prompt treatment decisions and better patient selection for recanalization treatments in recent years (Table S1). Indeed, a remarkably decreasing rate of patients treated despite baseline EIC (pc-ASPECTS < 8)…”