Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study

Schonewille, Wouter J.; Wijman, Christine A.C.; Michel, Patrik; Rueckert, Christina; Weimar, Christian; Mattle, Heinrich; Engelter, Stefan T.; Tanné, David; Muir, Keith W.; Molina, Carlos A.; Thijs, Vincent; Audebert, Heinrich J.; Pfefferkorn, Thomas; Szabo, Kristina; Lindsberg, Perttu J.; Freitas, Gabriel; Kappelle, L. Jaap; Algra, Ale

doi:10.1016/s1474-4422(09)70173-5

Cited by 645 publications

(669 citation statements)

References 18 publications

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“…[13][14][15][16][17][18] The largest adult series, the Basilar Artery International Cooperation Study (BASICS), reported 619 patients with BAO of whom over half (328 of 619) received intra-arterial tPA and other mechanical endovascular treatments. Overall mortality was 39%, and 31% survived with an mRankin scale score of 4 or 5 for a 70% frequency of 'poor outcome' by the authors' definition.…”

Section: Discussionmentioning

confidence: 99%

Basilar artery strokes in children: good outcomes with conservative medical treatment

Lagman-Bartolome

Pontigon

Moharir

et al. 2013

Develop Med Child Neuro

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Aim To describe outcomes and outcome predictors in childhood basilar artery stroke (BAS). Method We prospectively enrolled children with BAS with or without basilar artery occlusion (BAO) in the Toronto Children's Stroke Registry from 1992 to 2009. We assessed presenting features and outcomes including Pediatric Stroke Outcome Measure scores. Results Among 578 children with acute arterial ischemic stroke, 27 had BAS (4.6% including neonates, 6% excluding neonates). Twenty‐four (14 males, 10 females) children met study criteria (mean age at stroke was 8y 10mo; range 0–17y). Eleven children had BAO. Aspirin or anticoagulation was given to 15 children. None received tissue plasminogen activator or endovascular treatments. At mean follow‐up (3y 2mo, range 1mo–11y 8mo), 12 had a ‘good outcome’ (seven normal, five insignificant deficit) and 12 had ‘poor outcome’ (10 moderate or severe deficit, two acute deaths). Larger infarct size (≥50% of axial brainstem diameter) independently predicted poor outcome (p=0.02; odds ratio 21.2, 95% confidence interval 1.6–274.9) but not BAO, altered level of consciousness, or age. Interpretation Compared with adults, in childhood BAS death is rare and survivors frequently have good outcomes. Aggressive endovascular interventions may not be justifiable in this population.

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Section: Discussionmentioning

confidence: 99%

Basilar artery strokes in children: good outcomes with conservative medical treatment

Lagman-Bartolome

Pontigon

Moharir

et al. 2013

Develop Med Child Neuro

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“…Among them, 287 patients were diagnosed with acute BA occlusion and 201 patients underwent EVT for reperfusion. An acute BA occlusion was defined as a stroke with time from onset to groin puncture less than 24 h,9 using the onset time of symptoms consistent with the diagnosis of acute BA syndrome,2, 8 or the last time that the patient appeared normal if the exact onset was unidentifiable 2, 4. This study was reviewed and approved by the institutional review board of Seoul National University Hospital.…”

Section: Methodsmentioning

confidence: 99%

“…The time from stroke onset to groin puncture (onset‐to‐treatment) were categorized into <3, 3–6, 6–9, and >9 h throughout the analyses, according to the previous studies 2, 4. The location of BA occlusion was classified into proximal, middle, and distal, according to the most inferior extent of the obstruction.…”

Section: Methodsmentioning

confidence: 99%

“…To evaluate the association of stroke mechanism with the clinical outcomes, a logistic regression analysis including the stroke mechanism and the previously recognized outcome parameters such as age, hypertension, NIHSS scores, location of occlusion, collateral status, onset‐to‐treatment time, and reperfusion/recanalization,2, 4, 5, 7, 10, 14, 18, 19, 20 as well as the parameters with a P < 0.20 in univariate analysis, was performed for the entire study population using a full model fit. Then, a full model fit logistic regression analyses for the outcome factors were performed again separately in each group of stroke mechanism.…”

Section: Methodsmentioning

confidence: 99%

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Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Lee

Jung

Ryu

et al. 2018

Ann Clin Transl Neurol

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ObjectiveWe aimed to evaluate the impact of underlying mechanism of basilar artery (BA) occlusion on the outcomes after endovascular therapy (EVT) for reperfusion and the outcome factors associated with each mechanism, and to identify radiologic parameters enabling to distinguish the underlying mechanism.MethodsFrom a registry database, 194 consecutive patients with acute BA occlusion who underwent EVT were analyzed. Stroke mechanism, classified into in situ atherosclerotic thrombosis (ISAT) and embolism, clot sign location profiles in pre‐angiography magnetic resonance image (MRI), parameters of angiography and EVT, and reperfusion were assessed. Poor outcome was defined as a modified Rankin‐Scale score at 90 days of 3–6.ResultsThe mean age was 68.8±11.8 years (range 21–92 years) and seventy‐eight (40.2%) were female patients. 102 (52.6%) patients were classified into an embolism mechanism and 92 (47.4%) into an ISAT mechanism. Overall, ISAT mechanism compared with embolism was significantly associated with poor outcomes (P = 0.002), along with the NIHSS scores, reperfusion status, and collateral status. In the embolism group, reperfusion (P = 0.001), NIHSS scores (P < 0.001), and onset‐to‐treatment time (P = 0.030) were significant outcome factors. However, in the ISAT group, baseline collateral status (P = 0.001) and NIHSS scores (P < 0.001) were significant outcome factors. A clot sign at the distal BA segment on pre‐angiography MRI was strongly associated with embolism mechanism (P < 0.001).InterpretationStroke mechanism has a major influence on outcomes, and outcome predictors differ according to the underlying mechanism in acute BA occlusion with EVT. Clot sign profile on pre‐angiography MRI might be useful to determine the underlying mechanism.

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“…The outcome and mortality associated with BAO are worse than those associated with anterior circulation stroke 1, 2, 3. Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke,4 the effectiveness and safety of modern thrombectomy remains uncertain for patients with acute BAO.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

115

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BackgroundDespite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.Methods and ResultsThis study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique.ConclusionsEndovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO.

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Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study

Cited by 645 publications

References 18 publications

Basilar artery strokes in children: good outcomes with conservative medical treatment

Basilar artery strokes in children: good outcomes with conservative medical treatment

Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

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