Published Online
on February 22, 2007

A more recent version of this article appeared on April 1, 2007

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Submitted on October 23, 2006
Accepted on October 31, 2006

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; and 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 Grohadern, Ludwig-Maximilians-University Munich; the Department of Neurology (B.V.), University of Regensburg, Regensburg, Germany; the Department of Neuroradiology (T.E.M.), Klinikum Grohadern, Ludwig-Maximilians-University Munich; and the Department of Neurology (D.S.), Klinikum Rechts der Isar, Technical University Munich, Munich, Gemany.

^* To whom correspondence should be addressed. 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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