Abstract P478: One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Background and Objective: To report the results of clinical follow-up at 1 year among patients in the BASILAR registry. Design, Setting, and Participants: The BASILAR study was an investigator-initiated prospective registry, which consecutively enrolled stroke patients with acute basilar artery occlusion from 47 comprehensive stroke centers in China between January, 2014, and May, 2019. Patients were divided into conventional treatment or endovascular treatment groups according to the treatment their received. We assessed clinical outcomes 1 year after patients were enrolled in the BASILAR registry. Main Outcomes and Measures: The primary outcome was the score on the modified Rankin scale (range, 0 to 6 points, with higher scores indicating more severe disability) at 1 year assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. Secondary outcomes included categories scores of the modified Rankin scale at 1 year (0 to 1 [excellent outcome], 0 to 2 [good outcome], and 0 to 3 [favorable outcome]), and death from any cause during the 1-year period after enrollment. Results: Of the 829 patients who were enrolled in the original study, 1-year data for this extended follow-up study were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin scale favored endovascular treatment over conventional treatment (adjusted common odds ratio, 4.50; 95% confidence interval [CI], 2.81 to 7.29; P < 0.001). There were significant differences between the treatment groups in the percentage of patients who had excellent outcome, good outcome and favorable outcome. The cumulative 1-year mortality rate was 54.6% in the endovascular treatment group and 83.5% in the conventional treatment group (adjusted hazard ratio, 4.36; 95% CI, 2.69 to 7.29; P < 0.001). Conclusions and Relevance: In this extended follow-up study, the beneficial effect of endovascular treatment on functional outcome at 1 year in patients with acute basilar artery occlusion was similar to that reported at 90 days in the original study.

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One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽

10.1161/strokeaha.120.033658 ◽

2021 ◽

Author(s):

Fengli Li ◽

Hongfei Sang ◽

Jiaxing Song ◽

Zhangbao Guo ◽

Shuai Liu ◽

...

Keyword(s):

Treatment Group ◽

Endovascular Treatment ◽

Basilar Artery ◽

Odds Ratio ◽

Conventional Treatment ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Common Odds Ratio ◽

One Year

Background and Purpose: The BASILAR registry, a nationwide prospective nonrandomized study conducted in China, enrolled consecutive patients with acute basilar artery occlusion receiving endovascular treatment or conventional-treatment from January 2014 to May 2019. This article aimed to report the results of clinical follow-up at one year among these patients. Methods: The primary outcome was the modified Rankin Scale at one year, assessed as a common odds ratio using ordinal logistic regression analysis adjusted for prespecified prognostic factors. Secondary outcomes included the modified Rankin Scale-based outcome group at one year (0–1, 0–2, or 0–3) and all-cause death. Results: Of the 829 patients enrolled in the original BASILAR registry, one-year data were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin Scale favored endovascular treatment over conventional-treatment (adjusted common odds ratio, 4.50 [95% CI, 2.81–7.29]; P <0.001). The cumulative one-year mortality rate was 54.6% in the endovascular treatment group versus 83.5% in the conventional-treatment group (adjusted odds ratio, 4.36 [95% CI, 2.69–7.29]; P <0.001). Conclusions: The beneficial effect of endovascular treatment on functional outcome at one year in patients with acute basilar artery occlusion is similar to that reported at 90 days in the original study. REGISTRATION: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR1800014759.

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Republished: Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013277.rep ◽

2018 ◽

Vol 10 (7) ◽

pp. e17-e17 ◽

Cited By ~ 2

Author(s):

D Andrew Wilkinson ◽

Aditya S Pandey ◽

Hugh J Garton ◽

Luis Savastano ◽

Julius Griauzde ◽

...

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Time Window ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Posterior Fossa Decompression ◽

Modified Rankin Scale ◽

Basilar Artery Thrombosis ◽

Artery Thrombosis

Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with vertebral artery thrombosis and cerebellar stroke requiring posterior fossa decompression. She later progressed to basilar artery thrombosis treated with mechanical thrombectomy 50 hours after clinical decline. At 3 month follow-up, the patient had a modified Rankin Scale score of 0.

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Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion

International Journal of Stroke ◽

10.1177/17474930211052262 ◽

2021 ◽

pp. 174749302110522

Author(s):

Gabriel Broocks ◽

Tobias D Faizy ◽

Lukas Meyer ◽

Maximilian Groffmann ◽

Sarah Elsayed ◽

...

Keyword(s):

Computed Tomography ◽

Endovascular Treatment ◽

Functional Outcome ◽

Basilar Artery ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Poor Outcomes ◽

The Impact

Background In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. Aim This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. Methods In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0–2 at day 90). Results A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25–16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9–5.8). Conclusion PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.

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Stent Retriever-Assisted Mechanical Thrombectomy for Acute Basilar Artery Occlusion: Single US Institution Experience

Operative Neurosurgery ◽

10.1227/neu.0000000000001163 ◽

2015 ◽

Vol 12 (3) ◽

pp. 250-259 ◽

Cited By ~ 4

Author(s):

Ashish Sonig ◽

Chandan Krishna ◽

Sabareesh K Natarajan ◽

Jian Liu ◽

L Nelson Hopkins ◽

...

Keyword(s):

Standard Deviation ◽

Scale Score ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Stent Retrievers

Abstract BACKGROUND Acute basilar artery occlusion causes devastating strokes that carry high mortality and morbidity. OBJECTIVE To report the outcomes of mechanical thrombectomy in the posterior circulation with a focus on safety and efficacy of stent retrievers. METHODS We retrospectively reviewed our endovascular database for all patients treated with stent retrievers for posterior circulation stroke between June 2012 and June 2014. Twelve patients were identified. The following data were analyzed: thrombus location, previous stroke or transient ischemic attack, thrombus etiology, comorbidities, time from presentation to initiation of endovascular treatment, time from start of angiography to revascularization, and whether intravenous tissue plasminogen activator was administered pre-thrombectomy. Outcome was considered poor when modified Rankin Scale score was >2. RESULTS Mean patient age was 63.42 years (median, 64.5; range, 28-83 years); 7 were women. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 11 of 12 patients (91.7%). Mean discharge modified Rankin Scale score was 2.3 (median, 2.0; standard deviation 1.96; range, 0-6), with a favorable discharge outcome in 9 of 12 (75%) patients. Two patients died as inpatients. Mean follow-up modified Rankin Scale score was 1.4 (median, 1.00; standard deviation 1.075; range, 0-4). Good outcome was achieved in 9 of 10 (90%) patients at last follow-up (mean follow-up duration, 132.42 days [median, 90.50; standard deviation 80.2; range, 8-378 days]). CONCLUSION Our single-institution study has shown that good clinical outcomes and successful recanalization with acceptable mortality can be achieved with current stent retrievers.

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Endovascular Treatment for Acute Basilar Artery Occlusion: A Nationwide Prospective Registry

SSRN Electronic Journal ◽

10.2139/ssrn.3489308 ◽

2019 ◽

Author(s):

Wenjie Zi ◽

Zhongming Qiu ◽

Deping Wu ◽

Fengli Li ◽

Hansheng Liu ◽

...

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Endovascular Treatment in Acute Basilar Artery Occlusion “Experience in Indian Patients”

10.1055/s-0041-1730528 ◽

2019 ◽

Author(s):

Pokhraj Prakashchandra Suthar ◽

Hemen I. Vithlani ◽

Kamaldeep Chawla

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Indian Patients

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Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Stroke ◽

10.1161/strokeaha.111.622175 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3454-3459 ◽

Cited By ~ 42

Author(s):

Volker Puetz ◽

Andrei Khomenko ◽

Michael D. Hill ◽

Imanuel Dzialowski ◽

Patrik Michel ◽

...

Keyword(s):

Functional Outcome ◽

Ct Angiography ◽

Basilar Artery ◽

Functional Independence ◽

Artery Occlusion ◽

Posterior Circulation ◽

Favorable Outcome ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Scale Scores

Background and Purpose— The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). Methods— BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2). Results— Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS <8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5). Conclusions— pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.

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