Purpose Basilar artery occlusion is a devastating event without treatment. With the advent of mechanical and endovascular therapy, one would expect an improvement in outcomes.
Materials and methods We retrospectively reviewed patient records on 17 patients who presented with acute basilar artery thromboembolism and underwent an interventional procedure. The admission clinical findings, CT and CT angiogram, angiographic images and follow-up CT/MRI were reviewed. Clinical follow-up was also recorded. Statistical methods to analyze the findings were performed using JMP software.
Results 12% of patients had a good outcome and 18% were lost to follow-up. NIH stroke scale at admission had a direct correlation with outcome (modified Rankin scale). Recanalization did not directly correlate with outcome. Postprocedure hemorrhage was higher with larger doses of tissue plasminogen activator (tPA) and adding a mechanical device (MERCI) did not significantly improve outcome compared with tPA. Older age, higher admission National Institutes of Health Stroke Scale (NIHSS) were indicators of an adverse outcome. Complete basilar occlusion was associated with a worse outcome than a partial occlusion but the difference did not approach statistical significance.
Conclusions In this single center experience analysis, we were unable to identify any statistically significant angiographic predictors of outcome. Specifically, recanalization of the basilar artery did not correlate with good outcome. NIHSS at admission was an independent predictor of outcome. Basilar occlusion remains a complex and debilitating condition that is not satisfactorily treated by any current methods, including interventional techniques.
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Competing interests AR—Concentric Medical.