Abstract 136: Treatment of Basilar Artery Occlusion Without Time Constraints: Clinical outcomes, safety and predictors of favorable results
Background: Because acute stroke due to basilar artery occlusion (BAO) without recanalization (spontaneous or treated) carries a poor prognosis, recanalization treatment is increasingly initiated beyond conventional time windows. We report our experience with endovascular treatment for this condition when patients are selected without regards to time window considerations.
Methods: A retrospective review of a prospectively acquired database comprising 667 patients treated with endovascular therapy for acute stroke due to large vessel intracranial occlusions from 2000 to date. All patients presenting with BAO were included. Selection of patients occurred at the discretion of the treating stroke neurologist not necessarily based on time but based on clinical and imaging characteristics that led to the belief in a reasonable chance of a good outcome. Successful recanalization was expressed as Thrombolysis in Myocardial Infarction (TIMI) score ≥ 2. Favorable outcomes were considered 3 month modified Rankin Score (mRS) ≤ 2. Any parenchymal hematoma (PH) was considered symptomatic.
Results: We identified 85 patients. Median age: 63. Median admission NIHSS: 18 (IQR 11-29). Male sex: 57.6%. Median time from last seen well (TLSW) to groin puncture: 774 min (12.9 hrs) (IQR 324min-2262min). Median procedure duration: 105.5 min (IQR 67min-145min). 18% of patients received IV tPA. TIMI 2-3 recanalization occurred in 87% of patients treated. Favorable outcomes were noted in 34% of patients. mRS of 3 was achieved in 9.4%. Mortality was 46%. PH was noted in 8.2% of patients. Treatment modalities included IA lytics (56.4%), MERCI device (39%), Penumbra (6%), Manual Aspiratoin Thrombectomy (27%), Stenting (42%), Angioplasty (46%). In 76.4% of patients the procedure was carried out in intubated state. In multivariate analysis, age (OR 0.94, P=0.007, 95% CI 0.89-0.98), successful recanalization (OR 16, P=0.027, 95% CI 1.38-197.56) and admission glucose (OR 0.98, P=0.033, 95%CI 0.97-0.99) were found to be significantly associated with favorable outcomes. Of note TLSW to treatment initiation was not found in univariate or multivariate analyses to be significantly associated with favorable outcomes.
Conclusions: This single center experience indicates that endovascular treatment in selected patients with BAO without time window considerations is associated with similar rates of symptomatic hemorrhage (SICH) and rates of favorable outcomes compared to available literature data where selection is based on strict time windows. The role of time as selection criteria for treatment of BAO should be clarified by future prospective trials.
- © 2012 by American Heart Association, Inc.