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.
Bhatti A, Sivakumaran P. Intra-arterial Treatment for Basilar Artery Occlusion. JAMA Neurol. 2017;74(1):130. doi:10.1001/jamaneurol.2016.4810
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: