Abstract T MP27: Outcome Predictors in Basilar- versus Proximal Middle Cerebral Artery Occlusion: Data from the Endostroke-Registry
Background and Purpose: Large vessel stroke is frequently associated with poor long-term clinical outcome despite multimodal treatment approaches. Here we compare outcome predictors in angiographic proven proximal Middle Cerebral Artery (MCA)- versus Basilar Artery (BA) occlusion undergoing endovascular stroke treatment (EVT).
Methods: ENDOSTROKE is an investigator-initiated, industrially-independent multicenter, multinational registry for consecutive patients undergoing EVT for large vessel stroke. This analysis focuses on patients with angiographically proven M1-MCA (n=352) or BA-occlusion (n=121). Recanalization was defined as Thrombolysis in Cerebral Ischemia (TICI) scores 2b-3, good outcome as a Modified Rankin Scale (MRS) score of 0-2 assessed after 3 months.
Results: 77% of MCA- and 77% of BA-occlusions reached TICI 2b-3 recanalization, but good clinical outcome was achieved in only 31% vs. 40% of BA- vs. MCA-occlusions (n.s., Mann-Whitney-Test). Median age was 67 years (25th and 75th percentile: 59, 77) in BA-occlusion and 70 (58, 77) in MCA-occlusion (n.s.). Admission-NIHSS was significantly higher in BA-occlusion (22 (10, 29)) than in MCA-occlusion (15 (12, 19), p<0.001). Serum glucose and thromboycte count were not significantly different between MCA- and BA-occlusions. In MCA-occlusion, independent factors significantly associated with good clinical outcome were lower age, lower initial NIHSS, lower glucose as well as TICI 2b-3 recanalization. In BA-occlusion, only lower initial NIHSS was significantly associated with good clinical outcome (univariate and multivariate analysis). Time to recanalization was not significantly related to outcome in MCA- or BA-occlusions.
Conclusions: While initial stroke severity is a potent prognostic factor in both, MCA- and BA-occlusion, other classical outcome predictors, especially patients′ age do not seem to be of as high importance in BA-occlusion as in MCA-occlusion. Presumably, those predictors are offset by the exact site of BA-occlusion (i.e. mid-basilar vs. top of the basilar) leading to differences in initial stroke severity and potentially early irreversible tissue damage to pivotal brain stem structures.
Author Disclosures: O.C. Singer: None. J. Berkefeld: None.
- © 2014 by American Heart Association, Inc.