scholarly journals Blood pressure characteristics in patients with acute basilar artery occlusion undergoing endovascular thrombectomy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Slaven Pikija ◽  
Katharina Millesi ◽  
Monika Killer-Oberpfalzer ◽  
J. Sebastian Mutzenbach ◽  
Laszlo K. Sztriha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Basilar Artery ◽  
Reference Value ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Good Outcome ◽  
Frequent Use ◽  
Life Threatening ◽  
Lowering Drug ◽  
The Individual

Abstract Acute basilar artery occlusion (BAO) is a rare but potentially life-threatening neurological condition. While endovascular therapy (EVT) has been shown to improve outcome, there is limited knowledge about prognostic factors beyond early recanalization. We studied whether blood pressure (BP) exceeds or falls below suggested thresholds during intervention and whether these changes are associated with complications and outcome. BP measurements mostly with one-minute intervals were available in 39 patients. An individual systolic blood pressure (SBP) reference value was defined as the median of the first five intra-procedural measurements. Half of the patients (51.3%) received drugs for BP augmentation and two a BP lowering drug (5.1%). Thrombolysis in cerebral infarction grade 2b and 3 (TICI) was achieved in 29 (74.4%) and 23 patients (58.9%) had good outcome at three months. We observed a continuous intra-procedural increase of median SBP (+11%) and mean arterial pressure (MAP, +10%, both p < 0.001), and a unique temporal pattern of intermittent peaks and troughs. Successful recanalization was more common in patients whose intra-procedural duration with SBP under 140 mmHg was shorter (p = 0.009). Patients with isolated tip of basilar artery (TBA) occlusion had significantly more BP excursion of 20% below the reference SBP and required more frequent use of sympathomimetic drugs compared to vertebrobasilar occlusion (p = 0.008 and p = 0.041, respectively). Brain hemorrhage was more prevalent in patients who experienced SBP excursions at least 20% above the individual reference value (p = 0.038) and a longer duration of time spent with SBP above 180 mmHg (p = 0.029). Patients with higher pre-procedural mean SBP had a greater chance of a good outcome (p = 0.03). This study using high resolution BP monitoring suggests a relationship between intra-procedural BP characteristics and recanalization, hemorrhagic complications and outcome in patients receiving EVT for acute posterior circulation cerebrovascular syndromes. Differences with regard to BP regulation during recanalization therapy for vertebrobasilar and TBA occlusion deserves further attention.

scholarly journals Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion

Stroke ◽  
2015 ◽  
Vol 46 (10) ◽  
pp. 2972-2975 ◽  
Author(s):  
Woong Yoon ◽  
Seul Kee Kim ◽  
Tae Wook Heo ◽  
Byung Hyun Baek ◽  
Yun Young Lee ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Occlusion ◽  
Stent Retriever ◽  
Basilar Artery Occlusion ◽  
Good Outcome

scholarly journals Basilar Artery Occlusion. Clinical Evaluation and Contemporary Methods of Treatment

2021 ◽  
Vol 4 (01) ◽  
pp. 01-08
Author(s):  
Damyan Boychev
Keyword(s):  
Basilar Artery ◽  
Neurological Diseases ◽  
Intravenous Thrombolysis ◽  
Mortality Rates ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Threatening Condition ◽  
Life Threatening ◽  
Methods Of Treatment ◽  
Headache And Neck Pain

Acute occlusion of the basilar artery and its branches is a frequent cause of posterior circulation strokes. Although it accounts for only 1 to 3 % of ischemic strokes, it is a potentially life-threatening condition associated with high mortality rates. Exact clinical diagnosis is still challenging because symptoms such as vertigo, dizziness followed by headache, and neck pain are nonspecific and usually attributed to many other neurological diseases. The onset of symptoms can be abrupt or gradual and progressive. Establishing the time of symptoms onset and making a timely diagnosis is highly important. In case the diagnosis is made promptly, ideally with the help of an advanced neuroimaging, intravenous thrombolysis, or catheter-based endovascular treatment can be performed immediately to improve prognosis and reduce mortality.

scholarly journals Traumatic Vertebral Artery Dissection and Basilar Artery Occlusion/Stroke in a 7-Year-Old Child: A Case Report

2019 ◽  
Vol 08 (04) ◽  
pp. 233-237
Author(s):  
Binh Phung ◽  
Trusha Shah
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Life Threatening ◽  
Computed Tomography Angiogram

AbstractVertebral artery dissection (VAD) followed by basilar artery occlusion/stroke (BAO/BAS) is a rare but potentially life-threatening complication. We present a case report of a 7-year-old boy with VAD complicated by BAO/BAS 4 days after falling off a scooter. Symptoms included left-sided weakness and facial droop preceded by a 20-minute episode of altered sensorium. Magnetic resonance imaging showed ischemic changes in the left posterior inferior cerebellum and right pons. Computed tomography angiogram confirmed dissection of the left vertebral artery with occlusion/thrombosis of the basilar artery. Heparinization for 96 hours, followed by 6 months of low-molecular weight heparin injection, resulted in improvement of his neurological symptoms.

Abstract 1122‐000068: Basilar Artery Occlusion Thrombectomy Between Evidence Based Medicine and the Real‐World Practice, Single Centre Experience

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Islam El Malky ◽  
Ali Hendi ◽  
Hazem Abdelkhalek
Keyword(s):  
Clinical Outcome ◽  
Intracranial Hemorrhage ◽  
Basilar Artery ◽  
Real World ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Early Reperfusion ◽  
Good Outcome ◽  
Symptomatic Intracranial Hemorrhage ◽  
Multiple Variables

Introduction : BAO (basilar artery occlusion) is well known by catastrophic outcomes whether death or disability in approximately 70 %. 1 Thrombectomy as an intervention in large vessel occlusion of anterior proximal circulation was approved after multiple RCTs and meta‐analyses. 2 In spite of two RCTs that appeared lately, there is still uncertainty about the effect of thrombectomy in BAO. 9, 10 Our study aims to report the outcome of BAO, as a further clue of MT effectiveness in BAO and variables affecting good outcome and mortality rate. Methods : We retrospectively collected the clinical and radiological data of 30 BAO patients treated in our center between 2016 and 2020. There is no limitation as regard age or presenting NIHHS. Twenty‐two patients who came to the emergency within 4.5 hours had I.V. thrombolytic therapy (73.3%). A favorable clinical outcome was considered if mRS ≤ 2. Angioplasty, stenting, or I.A thrombolysis were used as a rescue treatment. Symptomatic intracranial hemorrhage within two days after the initiation of treatment and mortality at 90 days were reported. The radiological outcome was assessed by modified Thrombolysis in Cerebral Infarction (mTICI) score where mTICI ≥ 2b or 3 at the end of the intervention was considered a favorable radiological result. Multiple variables were tested for their effect on favorable clinical outcomes and mortality (Table 1). Results : Among 30 patients, the mean age was 61.23 ± 16.81 years; 20/30 (66.7%) male. A favorable functional outcome was achieved in (40.7%). Successful revascularization was achieved in 26 patients (86.7 %). Four patients had procedural complications (13.3%). Symptomatic intracranial hemorrhage occurred in three cases (11%) and mortality at 90 days was 11 patients (36.7 %). The presenting NIHSS is the only predictor of mortality and the optimal cut‐off value for death was 15 with AUC = 0.758 (sensitivity 91 % and specificity 59%) and p‐value = 0.02. TOR (time of onset to recanalization) had no effect on the clinical outcome which is controversy with the paradigm of early reperfusion leading to a good outcome Conclusions : In spite of two RCSs approved no statistical difference between medical treatment and thrombectomy, thrombectomy is still an effective procedure in real‐world practice in selected cases. The presenting NIHSS is the only predictor of mortality in our studies. More studies are warranted to discover other predictors of BAO thrombectomy outcome to improve case selection and avoid futile recanalization.

scholarly journals Outcome Predictors in Acute Basilar Artery Occlusion

2014 ◽  
Vol 41 (3) ◽  
pp. 368-374 ◽  
Author(s):  
Tomáš Dornák ◽  
Roman Herzig ◽  
David Školoudík ◽  
Daniel Šanák ◽  
Martin Kuliha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Basilar Artery ◽  
Neurological Deficit ◽  
Binary Logistic Regression ◽  
Treatment Method ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Binary Logistic Regression Analysis ◽  
Severe Stroke ◽  
Good Outcome

Objective:To identify predictors of good outcome in acute basilar artery occlusion (BAO).Background:Acute ischemic stroke (AIS) caused by BAO is often associated with a severe and persistent neurological deficit and a high mortality rate.Methods:The set consisted of 70 consecutive AIS patients (51 males; mean age 64.5±14.5 years) with BAO. The role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30- and 90-day outcome was assessed using the modified Rankin scale with a good outcome defined as a score of 0–3.Results:The following statistically significant differences were found between patients with good versus poor outcomes: mean age (54.2 vs. 68.9 years; p=0.0001), presence of arterial hypertension (52.4% vs. 83.7%; p=0.015), diabetes mellitus (9.5% vs. 55.1%; p=0.0004) and severe stroke (14.3% vs. 65.3%; p=0.0002), neurological deficit at time of treatment (14.0 vs. 24.0 median of National Institutes of Health Stroke Scale [NIHSS] points; p=0.001), successful recanalization (90.0% vs. 54.2%; p=0.005), change in neurological deficit (12.0 vs. 1.0 median difference of NIHSS points; p=0.005). Stepwise binary logistic regression analysis identified age (OR=0.932, 95% CI=0.882–0.984; p=0.012), presence of diabetes mellitus (OR=0.105, 95% CI=0.018–0.618; p=0.013) and severe stroke (OR=0.071, 95% CI=0.013–0.383; p=0.002) as significant independent negative predictors of good outcome.Conclusions:In the present study, higher age, presence of diabetes mellitus and severe stroke were identified as significant independent negative predictors of good outcome.

Age and discharge modified Rankin score are associated with 90-Day functional outcome after basilar artery occlusion treated with endovascular therapy

2021 ◽  
pp. 159101992098704
Author(s):  
Rahul R Karamchandani ◽  
Dale Strong ◽  
Jeremy B Rhoten ◽  
Tanushree Prasad ◽  
Jacob Selig ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Univariate Analysis ◽  
Prognostic Indicator ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Multivariable Logistic Regression Analysis ◽  
Stroke Registry ◽  
Good Outcome

Introduction Prognostic factors for functional outcome after basilar artery occlusion (BAO) treated with modern endovascular therapy (EVT) are sparse. We investigated the association between clinical characteristics, readily available imaging variables, and outcome in BAO patients treated with EVT. Methods Retrospective analysis from a large healthcare system’s prospectively collected code stroke registry of acute BAO patients treated with EVT between January 2017–January 2020. The primary outcome measure was a favorable 90-day modified Rankin score (mRS) of 0-2. Results 65 patients (median age 67 years, 57% male, median NIHSS 16) met the study inclusion criteria. Thrombolysis in Cerebral Infarction (TICI) 2 b-3 revascularization was achieved in 57/65 patients (88%) with a median time to revascularization of 445 minutes [IQR 302-840]. Ninety-day good outcome was seen in 35% (23/65) of patients. In a univariate analysis, age, history of ischemic stroke, baseline NIHSS, BAO site, and discharge mRS were associated with significant differences between the good and poor outcome groups. A multivariable logistic regression analysis demonstrated an independent association with 90-day good outcome and younger age (per 1-year, OR 0.79, 95% CI 0.64, 0.98) and good discharge mRS (0-2) (OR > 999.99, 95% CI 13.26, > 999.99). Conclusions Patients presenting with an acute BAO treated with modern EVT have a good 90-day outcome in over one-third of cases. Age and discharge mRS are independently associated with good 90-day outcome. Additional studies may focus on factors that can enhance discharge function after BAO, a novel prognostic indicator for favorable 90-day outcome in our study.

Abstract W MP10: Outcome and Futile Recanalization in Basilar Artery Occlusion - Systematic Analysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Perttu J Lindsberg ◽  
Tiina Sairanen ◽  
Simon Nagel ◽  
Oili Salonen ◽  
Heli Silvennoinen ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Single Center ◽  
Systematic Analysis ◽  
Good Outcome ◽  
Endovascular Interventions ◽  
History Of ◽  
Stent Retrievers ◽  
The Cost

Background: Basilar artery occlusion (BAO) is a most devastating form of stroke, and the current wisdom is to reverse it with revascularization therapies. Pharmacological thrombolysis have been adjuncted or replaced with endovascular thrombectomy devices. The preferred approach remains unknown and most recanalizations are futile with no clinical benefit. Methods: To determine whether invasive, endovascular interventions are superior to pharmacological thrombolysis alone we analyzed systematically the reported outcomes produced by variable BAO recanalization protocols. Information was retrieved from 15 reports published from 2005 comprising 803 patients in 17 cohorts. In the largest single-center cohort (162, Helsinki), predictors of futile recanalization (FR;3-month modified Rankin Scale [mRS] score 4 to 6) were determined. Results: Good outcome was reported by pharmacological protocols less frequently than by mechanical approaches either alone or on-demand (24.4% vs. 35.5% %, p<0.001), accompanied by lower recanalization rates (70.9% vs. 84.1%, p<0.001)(Figure). Afforded by superior recanalization rate at 91%, good outcome was reached by primary thrombectomy with stent-retrievers in 36%, but at the cost of substantial FR rate at 60%. In the largest single-center cohort, the single most significant predictor was extensive baseline ischemia, increasing the odds of futility 20-fold (95%CI 4.39-92.29, p<0.001). Other attributes of futility were ventilation support and history of atrial fibrillation or previous stroke. Conclusion: Mechanical endovascular approaches have reported superior primary outcome rates over pharmacological thrombolysis in BAO. Stricter patient selection, most notably to exclude victims of already extended ischemia, would assist in translating excellent recanalization rates into improved clinical outcomes and more acceptable futility rates.

scholarly journals Basilar Artery Occlusion: Clinical Management and Therapy

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Marco Sparaco
Keyword(s):  
Basilar Artery ◽  
Clinical Presentation ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Prodromal Symptoms ◽  
Presenting Symptoms ◽  
Cranial Nerve Palsies ◽  
Life Threatening

Basilar artery occlusion is a potentially life-threatening subset of the larger category of posterior circulation strokes, carrying > 80% fatality rate without treatment. This condition accounts for about 1% to 4% of all ischemic strokes and is generally related to local atherothrombosis or cardioembolism.Diagnosis can be challenging because presenting symptoms are often non focal, such as headache, dizziness, and vertigo. The onset of the symptomatology can be abrupt without preceding events, abrupt with prodromal symptoms, or progressive and stuttering. Finally, the severity of clinical presentation may range from isolated cranial nerve palsies to tetraplegia, locked-in state, or coma.If basilar artery occlusion is readily recognized and confirmed with the aid of neuroimaging, intravenous thrombolysis or endovascular treatment can be undertaken immediately in order to recanalize the occluded artery and thus reduce mortality and improve outcome.

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