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(Stroke. 2007;38:1380.)
© 2007 American Heart Association, Inc.

Research Reports

Admission Facility Is Associated With Outcome of Basilar Artery Occlusion

Robert Müller, MD; Thomas Pfefferkorn, MD; Bijan Vatankhah, MD; Thomas E. Mayer, MD; Johannes Schenkel, MD, MPH; Martin Dichgans, MD; Dirk Sander, MD Heinrich J. Audebert, MD

From the Department of Neurology (R.M., J.S., H.J.A.), Klinikum Harlaching, Städtisches Klinikum München GmbH, Munich, Germany; the Department of Neurology (T.P., M.D.), Klinikum Großhadern, Ludwig-Maximilians-University Munich; the Department of Neurology (B.V.), University of Regensburg, Regensburg, Germany; the Department of Neuroradiology (T.E.M.), Klinikum Großhadern, Ludwig-Maximilians-University Munich; and the Department of Neurology (D.S.), Klinikum Rechts der Isar, Technical University Munich, Munich, Gemany.

Correspondence to Dr Heinrich Audebert, Stroke Unit, Guy’s and St. Thomas’ Hospital NHS Trust, Lambeth Palace St, London, SE1 7EH UK. E-mail Heinrich.audebert{at}gstt.nhs.uk

Background and Purpose— Basilar artery occlusion (BAO) is a stroke subtype with poor prognosis, but recanalizing therapies have been reported to be effective. We investigated whether initial admission to telemedically linked general hospitals with subsequent stroke-center transfer is related to poorer outcome than direct admission to stroke centers.

Methods— All BAO cases of 3 stroke centers in Munich and 1 center in Regensburg between March 1, 2003 and December 31, 2004 were included, either if patients were directly admitted to stroke centers (n=23) or had initial admission to general hospitals of the telemedical network for integrative stroke care (TEMPiS) and secondary transfer to stroke centers (n=16). BAO was defined as angiographically (CTA, MRI or conventional angiography) confirmed occlusion of the basilar artery. Baseline parameters and therapeutic procedures were recorded. One-year follow-up was conducted prospectively.

Results— Differences in baseline parameters were not statistically significant. Time from onset to first angiography was significantly longer in patients with secondary transfer (mean: 355±93 minutes versus 222±198 minutes; P<0.01), mainly attributable to transfer duration (mean:156±73 minutes). In-hospital mortality (22% versus 75%; P<0.01) and 1-year-mortality (30% versus 81%; P<0.01) were lower for patients with direct admission to stroke centers. Fifty-two percent of directly admitted patients versus 13% of patients with secondary transfer (P=0.02) were living at home after 1 year.

Conclusions— BAO patients who were admitted primarily to community hospitals had a worse prognosis. Patients with typical symptoms should have direct access to stroke centers, or may need bridging therapies.

Key Words: basilar artery occlusion • interhospital transfer • telemedicine

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