scholarly journals A Simplified NIH Stroke Scale for Acute Basilar Artery Occlusion Treated with Endovascular Therapy

2020 ◽  
Author(s):  
Xu Tong ◽  
Jiayi An ◽  
Raynald Liu ◽  
Xuan Sun ◽  
Feng Gao ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Endovascular Therapy ◽  
Interobserver Reliability ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Predictive Tool ◽  
Assessment Time ◽  
Stroke Center

Abstract Background To design a simplified NIH Stroke Scale (sNIHSS) that requires minimal training but can reflect acute basilar artery occlusion (BAO) severity and is predictive for the 90-day outcome after endovascular therapy (EVT). Methods We analyzed the prospectively gathered data of acute BAO treated with EVT in a tertiary stroke center during a 6-year period. The sNIHSS (range: 0 to 20 points) consisted of 4 NIHSS items: level of consciousness - (1) questions and (2) commands; motor function - (3) arms and (4) legs. The 90-day outcomes included functional independence (mRS ≤ 2), favorable outcome (mRS ≤ 3) and death. Results Of 173 patients, 62, 83 and 36 achieved functional independence, favorable outcome and death, respectively. Interobserver reliability of sNIHSS was high (ICC = 0.95), and compared with NIHSS, sNIHSS had a significant reduction of assessment time (median: 1.5 min vs. 5 min, P < 0.01). A multivariable logistic model demonstrated that sNIHSS was independently associated with functional independence (OR = 0.82, 95% CI = 0.77-0.87), favorable outcome (OR = 0.86, 95% CI = 0.81-0.92) and death (OR = 1.24, 95% CI = 1.12-1.37). Additionally, the sNIHSS predicted 90-day outcomes almost as same discrimination as NIHSS by using DeLong test. The optimal cutoff value of sNIHSS was determined to be 12 points for predicting any outcome. Conclusions The sNIHSS reflects acute BAO severity well and predicts 90-day outcomes with reasonable accuracy. Nevertheless, the sNIHSS needs further validation before it can be applied as a predictive tool for acute BAO outcome.

scholarly journals Effect of anesthesia strategy during endovascular therapy on 90-day outcomes in acute basilar artery occlusion: a retrospective observational study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Haibin Du ◽  
Xu Tong ◽  
Xuan Sun ◽  
Zhiyong Shi ◽  
Bin Liu ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Clinical Outcomes ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion

Abstract Background and objective The research on the effect of anesthesia on endovascular therapy (EVT) of acute ischemic stroke is mainly focused on the anterior circulation, and little is known about the data of basilar artery occlusion (BAO). This study aims to investigate the association of anesthesia strategy with 90-day clinical outcomes of patients with acute BAO treated with EVT. Methods We reviewed our prospectively collected data from the endovascular treatment database at the Beijing Tiantan Hospital. This included patients with acute BAO who had a documented 90-day modified Rankin Scale (mRS) score from January 2012 to July 2018. Options for EVT included general anesthesia (GA) and conscious sedation (CS) performed by an anesthesia care team in the institution. The recommendation of anesthesia for patients was a joint decision between anesthesiologist and neurointerventionalist according to a pre-designed scheme. Patients who required tracheal intubation for airway protection prior to EVT were excluded. The clinical outcomes we observed were functional independence (mRS ≤2), favorable outcome (mRS ≤3), and mortality at 90 days after the procedure. Univariate and multivariable logistic regression analyses were used to explore the relationship between anesthesia methods and 90-day outcomes. Results A total of 187 patients with BAO were treated by EVT in this study. Nine cases requiring emergent intubation prior to EVT were excluded. 139 patients (78.1%) underwent GA and 39 patients (21.9%) underwent CS. In univariate analysis, GA was associated with less functional independence [odds ratio (OR), 0.28; 95% confidence interval (CI), 0.13–0.59] and less favorable outcome (OR, 0.23; 95% CI, 0.10–0.52) than was CS. After adjusting for potential confounders, multivariable analysis showed that there were still significant differences between GA and CS in functional independence (OR, 0.31; 95%CI, 0.10–0.97) and favorable outcome (OR, 0.24; 95%CI, 0.07–0.75). Conclusion Our retrospective analysis suggested that the anesthesia strategy may affect outcome, in which general anesthesia may result in less favorable outcomes. Nevertheless, future multicenter randomized controlled trials are needed to confirm our findings.

Abstract P619: A Non-Linear Relationship Between Time From Onset to Endovascular Therapy and Outcomes in Patients With Acute Basilar Artery Occlusion in Clinical Practice

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Hongfei Sang ◽  
Junjie Yuan ◽  
Shuai Liu ◽  
Weidong Luo ◽  
Fengli Li ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Symptomatic Intracerebral Hemorrhage

Objective: Faster time from onset to puncture (OPT) using endovascular therapy (EVT) in acute large-vessel occlusion of anterior circulation has been associated with better clinical outcomes. However, the relationship in acute basilar artery occlusion (BAO) is still not well delineated. Methods: We analyzed acute BAO patients receiving EVT from a nationwide registry of BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion study). The primary outcome was favorable functional outcome (defined as modified Rankin Scale score 0-3) at 90 days. Secondary outcomes included function independence (defined as modified Rankin Scale score 0-2), mortality and symptomatic intracerebral hemorrhage. The associations between OPT and outcomes were evaluated using multivariable logistic regression (OPT as a categorical variable) and restricted cubic spline regression (OPT as a continuous variable). Results: Among 639 eligible patients, the median age was 65 years, and median OPT was 328 mins (interquartile range, 220-490). Treatment within 4 hours were associated with higher rates of functional independence (adjusted OR, 0.60 [95% CI, 0.37-0.97] and 0.46 [95% CI, 0.22-0.97], respectively) and favorable outcome (adjusted OR, 0.63 [95% CI, 0.40-0.99] and 0.46 [95% CI, 0.24-0.96], respectively) compared with treatment within 4-8 hours and 8-12 hours. In the restricted cubic spline models, nonlinear relationships were consistently observed between OPT with favorable outcome, functional independence and mortality, with significant benefit loss throughout the first 10 hours but then a relative flat afterwards. However, the odds of symptomatic intracerebral hemorrhage did not significantly change with longer delay to EVT. Conclusion: Among patients with acute BAO in routine practice, earlier treatment with EVT was associated with better outcomes throughout the first 10 hours after onset, but benefit sustained unchanged afterwards. Future trials or pooled analysis of larger size BAO patients are needed to confirm these results.

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

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3454-3459 ◽  
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.

Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

2021 ◽  
Keyword(s):  
General Anaesthesia ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

Association Between Time to Endovascular Therapy and Outcomes in Patients With Acute Basilar Artery Occlusion

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012858
Author(s):  
Hong fei Sang ◽  
Jun jie Yuan ◽  
Zhongming Qiu ◽  
Min Zhang ◽  
Xiao gang Hu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Cubic Spline ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Spline Regression ◽  
Symptomatic Intracerebral Hemorrhage

Objective:To characterize the association of onset to puncture time (OPT) with clinical outcomes among patients with acute basilar artery occlusion receiving endovascular therapy (EVT) in clinical practice.Methods:Using the EVT for Acute Basilar Artery Occlusion (BASILAR) study, we identified consecutive patients with acute basilar artery occlusion receiving EVT in 47 comprehensive stroke centers in China from January 2014 to May 2019. The primary outcome was favorable functional outcome (defined as modified Rankin Scale score [mRS] 0–3) at 90 days. Secondary outcomes included function independence (mRS 0–2), mortality, and symptomatic intracerebral hemorrhage. The associations of OPT with clinical outcomes were analyzed using multivariable logistic regression (OPT as a categorical variable) and restricted cubic spline regression (OPT as a continuous variable).Results:Among 639 eligible patients, the median age was 65 years, and median OPT was 328 min (interquartile range, 220–490). Treatment within 4–8 hours and 8–12 hours were associated with lower rates of favorable outcome (adjusted OR, 0.63 [95% CI, 0.40–0.98] and 0.47 [95% CI, 0.23–0.93], respectively) compared with treatment within 4 hours. Restricted cubic spline regression analysis showed that the OPT had L-shaped associations with favorable outcome (Pnon-linearity=0.028) and functional independence (Pnon-linearity=0.025), with significant benefit loss throughout the first 9 hours but then appeared relatively flat. The odds of mortality increased relatively for OPT up to 9 hours, but then levelled off (Pnon-linearity=0.042). The association between symptomatic intracerebral hemorrhage and OPT was not significant.Conclusion:Among patients with acute basilar artery occlusion in routine practice, earlier treatment with EVT was associated with better outcomes throughout the first 9 hours after onset, but benefit may sustain unchanged afterwards.Classification of Evidence:This study provides Class II evidence that for patients with acute ischemic stroke due to basilar artery occlusion, earlier endovascular treatment is associated with better outcomes.

Bridging versus direct endovascular therapy in basilar artery occlusion

2021 ◽  
pp. jnnp-2020-325328
Author(s):  
Sergio Nappini ◽  
Francesco Arba ◽  
Giovanni Pracucci ◽  
Valentina Saia ◽  
Danilo Caimano ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Lower Mortality ◽  
Basilar Artery Occlusion ◽  
Bridging Therapy ◽  
Procedural Complications

BackgroundWe evaluated safety and efficacy of intravenous recombinant tissue Plasminogen Activator plus endovascular (bridging) therapy compared with direct endovascular therapy in patients with ischaemic stroke due to basilar artery occlusion (BAO).MethodsFrom a national prospective registry of endovascular therapy in acute ischaemic stroke, we selected patients with BAO. We compared bridging and direct endovascular therapy evaluating vessel recanalisation, haemorrhagic transformation at 24–36 hours; procedural complications; and functional outcome at 3 months according to the modified Rankin Scale. We ran logistic and ordinal regression models adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS), onset-to-groin-puncture time.ResultsWe included 464 patients, mean(±SD) age 67.7 (±13.3) years, 279 (63%) males, median (IQR) NIHSS=18 (10–30); 166 (35%) received bridging and 298 (65%) direct endovascular therapy. Recanalisation rates and symptomatic intracerebral haemorrhage were similar in both groups (83% and 3%, respectively), whereas distal embolisation was more frequent in patients treated with direct endovascular therapy (9% vs 3%; p=0.009). In the whole population, there was no difference between bridging and direct endovascular therapy regarding functional outcome at 3 months (OR=0.79; 95% CI=0.55 to 1.13). However, in patients with onset-to-groin-puncture time ≤6 hours, bridging therapy was associated with lower mortality (OR=0.53; 95% CI=0.30 to 0.97) and a shift towards better functional outcome in ordinal analysis (OR=0.65; 95% CI=0.42 to 0.98).ConclusionsIn ischaemic stroke due to BAO, when endovascular therapy is initiated within 6 hours from symptoms onset, bridging therapy resulted in lower mortality and better functional outcome compared with direct endovascular therapy.

Abstract TMP13: Tenecteplase versus Alteplase Before Endovascular Therapy in Basilar Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fana Alemseged ◽  
Volker Puetz ◽  
Gregoire Boulouis ◽  
Alessandro Rocco ◽  
Timothy Kleinig ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Endovascular Therapy ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Randomized Controlled ◽  
Repeat Imaging

Background: Tenecteplase (TNK) is a genetically modified variant of alteplase with greater fibrin specificity and longer half-life than alteplase. The recent Tenecteplase versus Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK) trial demonstrated that increased reperfusion with TNK compared to alteplase prior to endovascular thrombectomy (EVT) in large vessel occlusion ischaemic strokes. However, only 6 patients with basilar artery occlusion (BAO) were included. We aimed to investigate the efficacy of TNK versus alteplase before EVT in patients with basilar artery occlusion (BAO). Methods: Clinical and procedural data of consecutive BAO diagnosed on CT Angiography or MR Angiography from the multisite international Basilar Artery Treatment and MANagement (BATMAN) collaboration were retrospectively analysed. The primary outcome was reperfusion of greater than 50% of the involved ischemic territory or absence of retrievable thrombus at the time of the initial angiographic assessment. Results: We included 119 BAO patients treated with intravenous thrombolysis prior to EVT; mean age 68 (SD 14), median NIHSS 16 (IQR 7-32). Eleven patients were treated with TNK (0.25mg/kg or 0.4mg/kg) and 108 with alteplase (0.9mg/kg). Overall, 113 patients had catheter angiography or early repeat imaging after thrombolysis. Reperfusion of greater than 50% of the ischemic territory or absence of retrievable thrombus occurred in 4/11 (36%) of patients treated with TNK vs 8/102 (8%) treated with alteplase (p=0.02). Onset-to-needle time did not differ between the two groups (p=0.4). Needle-to-groin-puncture time was 61 (IQR 33-100) mins in patients reperfused with TNK vs 111 (IQR 86-198) mins in patients reperfused with alteplase (p=0.048). Overall, the rate of symptomatic haemorrhage was 3/119 (2.5%). No differences were found in the rate of symptomatic intracranial haemorrhage (p=0.3) between the two thrombolytic agents. Conclusions: Despite shorter needle-to-groin-puncture times, tenecteplase was associated with an increased rate of reperfusion in comparison with alteplase before EVT in BAO. Randomized controlled trials to compare tenecteplase with alteplase in BAO patients before endovascular thrombectomy are warranted.

Abstract WP64: Perfusion Imaging Can Identify Basilar Occlusion Patients With a Favorable Response to Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Carlo W Cereda ◽  
Jeremy Heit ◽  
Giovanni Bianco ◽  
Marco Pileggi ◽  
Abid Qureshi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Basilar Artery ◽  
Perfusion Imaging ◽  
Univariate Analysis ◽  
Brain Regions ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Favorable Outcome ◽  
Cerebellar Hemisphere ◽  
Basilar Artery Occlusion

Introduction: Perfusion imaging can identify patients who respond favorably to endovascular therapy (EVT) in the anterior circulation; no data are available for the posterior circulation. We evaluated perfusion patterns, assessed with RAPID software, in a consecutive cohort of patients with basilar artery occlusion treated with EVT and assessed the association between reperfusion and favorable clinical outcome based on the perfusion profile. Hypothesis: We hypothesized that patients with limited regions of severe hypoperfusion (Tmax > 10s) would have a favorable response (mRS 0-2) to reperfusion (mTICI 2b-3) while patients with multiple critical brain regions severely hypoperfused would have poor outcome (mRS 4-6) despite reperfusion. Methods: From a multicenter cohort of perfusion imaging in posterior circulation stroke, we included patients with basilar artery occlusion and EVT. We pre-specified a Critical Area Perfusion Score (CAPS, 0 - 8 points) to identify severe hypoperfusion (Tmax >10s) in the following regions: inferior and/or superior cerebellar hemisphere (1-4 points), pons (2 points), midbrain/thalamus (2 points). We compared the outcome between reperfusers and non reperfusers based on the CAP score with univariate and multivariate analysis. Results: 38 patients met the inclusion criteria. Mean age was 63±17, 34% female, NIHSS 17±11. In patients who reperfused (n=30, 79%) 63% had favorable outcome, while no patient without reperfusion survived, p=0.003 OR=29 (95%CI 1.5-547). Ninety percent (19/21) of reperfused patients with CAPS ≤2 had a favorable outcome, while none of the 9 with reperfusion and a score >2 survived, p<0.001, OR=148 (95%CI 6.5-3,333). In univariate analysis, favorable outcome was associated with NIHSS OR=0.87 (95% CI 0.80-0.96), p=0.003, and mismatch volume OR=0.98 (95% CI 0.97-0.997) p=0.013. In the multivariate analysis, only CAPS was an independent predictor of favorable outcome. Conclusions: Patients with limited regions of severe hypoperfusion (Tmax > 10s) had a robust response to basilar artery EVT, however, all patients with multiple critical brain regions severely hypoperfused died despite successful reperfusion. Perfusion imaging profiles may help identify optimal patients for basilar EVT.

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