Good Outcomes Are Possible for Basilar Artery Occlusion

Hooman Kamel, MD

Many patients without extensive ischemia on baseline imaging can recover well with aggressive modern stroke care.

Basilar artery occlusion traditionally has been considered a catastrophe with a high rate of poor outcomes. To gauge the effects of modern treatment and the predictive utility of baseline imaging, investigators at a single academic center studied a consecutive series of patients who underwent aggressive attempts at basilar artery recanalization between 1995 and 2012.

Of 184 patients with basilar artery occlusion, 95% received intravenous tissue plasminogen activator (TPA), and 97% of these also received full-dose intravenous heparin. Less than 10% underwent endovascular therapy. Many patients (40%) were treated within 6 hours of stroke onset, but 16% received treatment after 24 hours. Partial or complete recanalization occurred in 68% of the 145 patients who had posttreatment angiography.

In 52 patients, pretreatment computed tomography (CT) or magnetic resonance imaging showed extensive ischemia, defined as <8 on the posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS). Very few of these patients had a good 3-month outcome (modified Rankin Scale score ≤2): Even among those whose basilar artery was recanalized, only 6% had good outcomes. Conversely, 50% of the 82 patients without extensive baseline ischemia whose vessels were recanalized had good outcomes. Time from onset to treatment did not appear to influence outcome. Rates of symptomatic intracranial hemorrhage were approximately 29% in those with extensive baseline ischemia and 14% in those without.

Citation(s):

Strbian D et al. Thrombolysis of basilar artery occlusion: Impact of baseline ischemia and time. Ann Neurol 2013 Jul 8; [e-pub ahead of print].