Abstract WP26: Improved Clinical Outcome of Acute Basilar Artery Occlusion Since Introduction of Endovascular Thrombectomy Devices
Background: Survival and functional outcome of patients with acute basilar artery occlusion (BAO) are highly dependent on vessel recanalization. Therefore intra-arterial thrombolysis is recommended in international guidelines. For several years, thrombectomy-devices are used for intra-arterial therapy. We analyzed if the use of those devices modified the outcome of patients with BAO in our institution.
Method: Retrospective analysis of prospectively collected data on consecutive patients with acute BAO since 1998. In July 2009 for the first time a thrombectomy device was used in a patient with BAO. Thereafter the cohort was split into two chronological groups. All patients were treated at a dedicated neurological ICU following institutional SOPs. Functional outcome was assessed three months after treatment using the modified Rankin Scale (mRS); good clinical outcome was defined as mRS 0-2. Symptomatic intracranial hemorrhage (sICH) was defined as intracranial blood on follow-up imaging up to 36 hours after treatment associated with clinical worsening of at least 4 points of the NIHSS or leading to death.
Results: From the entire cohort of N=124 patients, n=91 patients were treated before and n=33 after July 2009. A “bridging concept” (i.e. IVT + IAT) was applied in 20% vs. 64% of the patients before and after July 2009, respectively. Complete recanalization (TICI 3) was achieved in 45% before and 77% after July 2009 (p=0.005). SICH occurred in 7% of the earlier and 3% of the later cohort (p=0.67); good clinical outcome was observed in 10% of the earlier and 33% of the later cohort (p=0.004); mortality was 57% in the earlier and 30% in the later group (p=0.01). After adjustment for baseline imbalances (proportion of patients with previous stroke, time until first treatment) the differences remained significant for good clinical outcome (OR 3.86; 95%CI 1.27 - 11.7; p=0.017) and mortality (OR 0.38; 95%CI 0.15-0.99; p=0.047).
Conclusion: Modern thrombectomy-devices as well as the increased use of bridging approaches for treatment of BAO have significantly improved good clinical outcome and attenuated mortality. Especially in patients with BAO - where endovascular treatment strategies are common clinical practice - those devices should be used more frequently.
- © 2012 by American Heart Association, Inc.