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Original Investigation
October 2016

Safety and Outcome of Intra-Arterial Treatment for Basilar Artery Occlusion

Author Affiliations
  • 1Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 2Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
JAMA Neurol. 2016;73(10):1225-1230. doi:10.1001/jamaneurol.2016.1408
Key Points

Question  How should we treat patients with acute basilar artery occlusion (BAO) in light of the conclusively positive results of intra-arterial treatment for ischemic stroke in the anterior circulation?

Findings  In this case series of 38 endovascular-treated patients with BAO, 19 patients had a favorable outcome. These results are more advantageous than older data and comparable to those of recent thrombectomy trials in anterior circulation stroke.

Meaning  Clinicians could consider providing additional intra-arterial treatment as part of standard care for patients with BAO.

Abstract

Importance  After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO).

Objective  To report up-to-date outcome data of intra-arterial (IA) treatment in patients with BAO and to evaluate the influence of collateral circulation on outcome.

Design, Setting, and Participants  Single-center retrospective case series of 38 consecutive patients with BAO who underwent IA treatment between 2006 and 2015 at a comprehensive stroke center.

Exposures  Intra-arterial treatment by mechanical thrombectomy and/or IA thrombolysis.

Main Outcomes and Measures  Adequate recanalization was defined as a score of 2b or 3 on the Thrombolysis in Cerebral Infarction score. Favorable outcome was defined as a modified Rankin Scale of 0 to 3 at first follow-up. Imaging data on the patency of the vertebral arteries and posterior communicating arteries, as well as the presence of cerebellar arterial anastomosis, were recorded and posttreatment imaging results were reviewed.

Results  Of the 38 patients with BAO, mean (SD) age was 58 (16) years, and 21 (55%) were male. Twenty-seven patients (71%) were treated with intravenous thrombolysis before IA therapy. Mechanical thrombectomy was applied to 30 patients, and 7 patients received local urokinase without thrombectomy. The median National Institutes of Health Stroke Scale score was 21 (interquartile range [IQR], 15-32) points, and median time to IA treatment was 288 (IQR, 216-380) minutes. Adequate recanalization was achieved in 34 of 38 cases (89%). Functional outcome was favorable in 19 (50%) patients. No association between patent collateral circulation and favorable outcome was found. Symptomatic intracranial hemorrhage occurred in 2 patients (5%).

Conclusions and Relevance  The proportion of patients reaching a favorable outcome in our study is comparable to the IA-treated group of the MR CLEAN trial and better than the results reported in the BASICS registry, suggesting that IA intervention in patients with BAO is an effective and safe treatment modality in daily clinical practice.

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