Hostname: page-component-5cf477f64f-r2nwp Total loading time: 0 Render date: 2025-04-04T02:59:38.602Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome Predictors in Acute Basilar Artery Occlusion

Published online by Cambridge University Press:  23 September 2014

Tomáš Dornák ,
Roman Herzig ,
David Školoudík ,
Daniel Šanák ,
Martin Kuliha ,
Martin Roubec ,
Martin Köcher ,
Václav Procházka ,
Michal Král  and
Tomáš Veverka
...Show all authors
Tomáš Dornák
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
Roman Herzig*
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
David Školoudík
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc Department of Neurology, University Hospital and Ostrava University, Ostrava-Poruba, Czech Republic
Daniel Šanák
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
Martin Kuliha
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc Department of Neurology, University Hospital and Ostrava University, Ostrava-Poruba, Czech Republic
Martin Roubec
Affiliation:
Department of Neurology, University Hospital and Ostrava University, Ostrava-Poruba, Czech Republic
Martin Köcher
Affiliation:
Department of Radiology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
Václav Procházka
Affiliation:
Department of Radiology, University Hospital and Ostrava University, Ostrava-Poruba, Czech Republic
Michal Král
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
Tomáš Veverka
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
Petr Hluštík
Affiliation:
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
Jana Zapletalová
Affiliation:
Department of Medical Biophysics, Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký University, Olomouc
Miroslav Herman
Affiliation:
Department of Radiology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc
*
*Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, I. P. Pavlova 6, CZ-775 20 Olomouc, Czech Republic. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To identify predictors of good outcome in acute basilar artery occlusion (BAO).

Background:

Acute ischemic stroke (AIS) caused by BAO is often associated with a severe and persistent neurological deficit and a high mortality rate.

Methods:

The set consisted of 70 consecutive AIS patients (51 males; mean age 64.5±14.5 years) with BAO. The role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30- and 90-day outcome was assessed using the modified Rankin scale with a good outcome defined as a score of 0–3.

Results:

The following statistically significant differences were found between patients with good versus poor outcomes: mean age (54.2 vs. 68.9 years; p=0.0001), presence of arterial hypertension (52.4% vs. 83.7%; p=0.015), diabetes mellitus (9.5% vs. 55.1%; p=0.0004) and severe stroke (14.3% vs. 65.3%; p=0.0002), neurological deficit at time of treatment (14.0 vs. 24.0 median of National Institutes of Health Stroke Scale [NIHSS] points; p=0.001), successful recanalization (90.0% vs. 54.2%; p=0.005), change in neurological deficit (12.0 vs. 1.0 median difference of NIHSS points; p=0.005). Stepwise binary logistic regression analysis identified age (OR=0.932, 95% CI=0.882–0.984; p=0.012), presence of diabetes mellitus (OR=0.105, 95% CI=0.018–0.618; p=0.013) and severe stroke (OR=0.071, 95% CI=0.013–0.383; p=0.002) as significant independent negative predictors of good outcome.

Conclusions:

In the present study, higher age, presence of diabetes mellitus and severe stroke were identified as significant independent negative predictors of good outcome.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 3 , May 2014 , pp. 368 - 374
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Israeli-korn, SD, Schwammenthal, Y, Yonash-Kimchi, T. Ischemic stroke due to acute basilar artery occlusion: proportion and outcomes. Isr Med Assoc J. 2010 12 6715.Google Scholar
2.Mattle, HP, Arnold, M, Lindsberg, PJ, Schonewille, WJ, Schroth, G. Acute basilar occlusion. Lancet Neurol. 2011 10 100214.Google Scholar
3.Gadoth, A, Hallevi, H. Basilar artery occlusion presenting as a tonic-clonic seizure. Isr Med Assoc J. 2011 13 3145.Google Scholar
4.Caplan, LR. “Top of the basilar” syndrome. Neurology. 1980 30 729.CrossRefGoogle ScholarPubMed
5.Dornak, T, Herzig, R, Sanak, D, Skoloudik, D.Management of acute basilar artery occlusion: Should any treatment strategy prevail? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. In press 2013 Sep 27. [Epub ahead of print].Google Scholar
6.Taneja, SR, Hanna, I, Holdgate, A, Wenderoth, J, Cordato, DJ. Basilar artery occlusion in a 14-year old female successfully treated with acute intravascular intervention: case report and review of the literature. J Paediatr Child Health. 2011 47 40814.Google Scholar
7.Chen, MH, Wu, SL, Lo, MC, Chen, WL, Wang, WF. Basilar artery occlusion in a teenaged boy treated with intra-arterial thrombolysis. Acta Neurol Taiwan. 2010 19 2816.Google Scholar
8.Goeggel Simonetti, B, Ritter, B, Gautschi, M. Basilar artery stroke in childhood. Dev Med Child Neurol. 2013 55 6570.CrossRefGoogle ScholarPubMed
9.Jung, S, Mono, ML, Fischer, U. Three-month and long-term outcomes and their predictors in acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke. 2011 42 194651.Google Scholar
10.Sairanen, T, Strbian, D, Soinne, L. Intravenous thrombolysis of basilar artery occlusion: predictors of recanalization and outcome. Stroke. 2011 42 21759.CrossRefGoogle ScholarPubMed
11.Schonewille, WJ, Wijman, CA, Michel, P. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol. 2009 8 72430.CrossRefGoogle ScholarPubMed
12.Lindsberg, PJ, Mattle, HP. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke. 2006 37 9228.Google Scholar
13.Nagel, S, Schellinger, PD, Hartmann, M. Therapy of acute basilar artery occlusion: intraarterial thrombolysis alone vs bridging therapy. Stroke. 2009 40 1406.Google Scholar
16.The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7..Google Scholar
17.Higashida, RT, Furlan, AJ, Roberts, H. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003 34 e10937.Google Scholar
18.Arnold, M, Fischer, U, Compter, A. Acute basilar artery occlusion in the Basilar Artery International Cooperation Study: does gender matter?. Stroke. 2010 41 26936.Google Scholar
19.Hill, MD, Kent, DM, Hinchey, J. PROACT-2 Investigators. Sex-based differences in the effect of intra-arterial treatment of stroke: analysis of the PROACT-2 study. Stroke. 2006 37 23225.CrossRefGoogle ScholarPubMed
20.Schulte-Altedorneburg, G, Hamann, GF, Mull, M. Outcome of acute vertebrobasilar occlusions treated with intra-arterial fibrinolysis in 180 patients. AJNR Am J Neuroradiol. 2006 27 20427.Google Scholar
21.Levy, EI, Firlik, AD, Wisniewski, S. Factors affecting survival rates for acute vertebrobasilar artery occlusions treated with intra-arterial thrombolytic therapy: a meta-analytical approach. Neurosurgery. 1999 45 53948.Google Scholar
22.Greving, JP, Schonewille, WJ, Wijman, CA, Michel, P, Kappelle, LJ, Algra, A. Predicting outcome after acute basilar artery occlusion based on admission characteristics. Neurology. 2012 78 105863BASICS Study Group.Google Scholar
23.Strbian, D, Sairanen, T, Silvennoinen, H, Salonen, O, Kaste, M, Lindsberg, PJ. Thrombolysis of basilar artery occlusion: Impact of baseline ischemia and time. Ann Neurol. 2013 73 68894.Google Scholar
24.Vergouwen, MD, Algra, A, Pfefferkorn, T. Basilar Artery International Cooperation Study (BASICS) Study Group. Time is brain(stem) in basilar artery occlusion. Stroke. 2012 43 30036.CrossRefGoogle Scholar
25.Yu, YY, Niu, L, Gao, L. Intraarterial thrombolysis and stent placement for acute basilar artery occlusion. J Vasc Interv Radiol. 2010 21 135963.CrossRefGoogle ScholarPubMed
26.Kashiwagi, J, Kiyosue, H, Hori, Y. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty. Neuroradiology. 2010 52 36170.CrossRefGoogle ScholarPubMed
27.Pfefferkorn, T, Holtmannspötter, M, Schmidt, C. Drip, ship, retrieve: cooperative recanalization therapy in acute basilar artery occlusion. Stroke. 2010 41 7226.CrossRefGoogle ScholarPubMed
28.Lindsberg, PJ, Soinne, L, Tatlisumak, T. Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA. 2004 292 18626.CrossRefGoogle ScholarPubMed
29.Barlinn, K, Becker, U, Puetz, V. Combined treatment with intravenous abciximab and intraarterial tPA yields high recanalization rate in patients with acute basilar artery occlusion. J NeuroimAging. 2012 22 16771.Google Scholar
30.Mazighi, M, Meseguer, E, Labreuche, J, Amarenco, P. Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis. Stroke. 2012 43 13028.Google Scholar
31.van der Hoeven E. BASilar artery International Cooperation Study (BASICS) trial. [Cited 2013 Jul 15] Available from: http://basicstrial.com/Main.html.Google Scholar