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Comment & Response
January 2017

Intra-arterial Treatment for Basilar Artery Occlusion

Author Affiliations
  • 1Imperial College School of Medicine, Imperial College London, London, England
JAMA Neurol. 2017;74(1):130. doi:10.1001/jamaneurol.2016.4810

To the Editor We thank van Houwelingen et al1 for their retrospective study exploring the efficacy and safety of intra-arterial (IA) treatment in basilar artery occlusion (BAO). They reported adequate recanalization and favorable outcomes in the cohort receiving IA therapy after BAO.

We commend the authors’ stringent diagnostic workup to confirm the presence of BAO. However, we note that the mean age of the patient cohort was younger than 60 years, and given that this age demographic harbors fewer comorbidities compared with the older than 65 age group where stroke incidence is higher, this confers a favorable outcome regardless of the intervention. Furthermore, although some prestroke comorbidities have been accounted for, atrial fibrillation has not been considered. In patients with atrial fibrillation receiving systemic antithrombotic therapy, IA thrombolysis is contraindicated owing to the increased risk for an adverse intracranial hemorrhage,2 thus leaving stenting as the only suitable option. Therefore, the very nature of judgement-based treatment allocation leaves the door open for potential selection bias that may significantly affect outcome measures.