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Strbian D, Tsivgoulis G, Ospel J, Räty S, Cimflova P, Georgiopoulos G, Ullberg T, Arquizan C, Gralla J, Zelenak K, Hussain S, Fiehler J, Michel P, Turc G, van Zwam WH. European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion. J Neurointerv Surg 2024; 16:e7. [PMID: 39043395 PMCID: PMC11347260 DOI: 10.1136/jnis-2024-022053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 07/25/2024]
Abstract
The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology.Although BAO accounts for only 1-2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five representing the European Society of Minimally Invasive Neurological Therapy (ESMINT)) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements.First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (although in small numbers) in IVT trials. Non-randomized studies of IVT-only cohorts showed a high proportion of favorable outcomes. Expert Consensus suggests using IVT up to 24 hours unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared with BMT alone within 6 and 6-24 hours from last seen well. In both time windows, we observed a different effect of treatment depending on a) the region where the patients were treated (Europe vs Asia), b) on the proportion of IVT in the BMT arm, and c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with a National Institutes of Health Stroke Scale (NIHSS) score below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT+BMT over BMT alone (this is based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS score below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT+BMT over BMT alone in proximal and middle locations of BAO compared with distal location. While recommendations for patients without extensive early ischemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 hours after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty).
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Affiliation(s)
- Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Georgios Tsivgoulis
- Second Department of Neurology, 'Attikon' University Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Johanna Ospel
- Neuroradiology, Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Silja Räty
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Petra Cimflova
- Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Georgios Georgiopoulos
- Department of Physiology, School of Medicine, University of Patras, Patras, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Teresa Ullberg
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund and Malmö, Sweden
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, INSERM U1266, Montpellier, France
| | - Jan Gralla
- Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Kamil Zelenak
- Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | | | - Patrik Michel
- Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Bâtiment Hospitalier Principal, Lausanne, Switzerland
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, INSERM U1266, Université Paris Cité, FHU NeuroVasc, Paris, France
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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Chowdhury A, Killingsworth MC, Calic Z, Bhaskar SM. Meta-analysis of clinical and safety profiles after reperfusion therapy in acute posterior circulation strokes: insights and implications. Acta Radiol 2024; 65:982-998. [PMID: 38839085 DOI: 10.1177/02841851241255313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Posterior circulation stroke (PCS) accounts for approximately 20% of all acute ischemic strokes. The optimal reperfusion therapy for PCS management remains uncertain. PURPOSE To evaluate the prevalence and outcomes of intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and bridging therapy in PCS patients. MATERIAL AND METHODS We conducted a meta-analysis of 19 studies examining reperfusion therapy outcomes in PCS patients, including 9765 individuals. We pooled prevalence data and assessed associations between reperfusion therapies and clinical, safety, and recanalization outcomes using random-effects models. RESULTS The pooled prevalence of reperfusion therapies post-acute PCS was 39% for IVT, 54% for EVT, and 48% for bridging therapy. EVT was associated with significantly higher odds of favorable functional outcomes (modified Rankin Score [mRS] 0-3) at 90 days compared to standard medical therapy (odds ratio [OR] = 5.68; 95% confidence interval [CI]=2.07-15.59; P = 0.001). Conversely, bridging therapy was linked to reduced odds of favorable functional outcomes at 90 days compared to EVT (OR = 0.35; 95% CI=0.26-0.47; P < 0.001). Bridging therapy was also significantly associated with lower odds of good functional outcomes (mRS 0-2) (OR = 0.25; 95% CI=0.11-0.54; P < 0.001), reduced risk of symptomatic intracranial hemorrhage (OR = 0.26; 95% CI=0.07-0.68; P = 0.009), lower mortality (OR = 0.13; 95% CI=0.04-0.44; P = 0.001), and less successful recanalization (OR = 0.35; 95% CI=0.13-0.94; P = 0.038) relative to EVT. CONCLUSION Our meta-analysis underscores the favorable outcomes associated with EVT in PCS cases. With notable reperfusion rates, understanding factors influencing PCS outcomes can inform patient selection and prognostic considerations.
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Affiliation(s)
- Ashek Chowdhury
- Global Health Neurology Lab, Sydney, NSW, Australia
- South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Murray C Killingsworth
- Global Health Neurology Lab, Sydney, NSW, Australia
- South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Cell-Based Disease Intervention Group, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- NSW Health Pathology, NSW Brain Clot Bank, Sydney, NSW, Australia
- Department of Anatomical Pathology, NSW Health Pathology; Cell-Based Disease Intervention Research Group, Ingham Institute for Applied Medical Research and Liverpool Hospital, Liverpool, NSW, Australia
| | - Zeljka Calic
- Global Health Neurology Lab, Sydney, NSW, Australia
- South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Cell-Based Disease Intervention Group, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- NSW Health Pathology, NSW Brain Clot Bank, Sydney, NSW, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Sonu Mm Bhaskar
- Global Health Neurology Lab, Sydney, NSW, Australia
- South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Cell-Based Disease Intervention Group, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- NSW Health Pathology, NSW Brain Clot Bank, Sydney, NSW, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South Western Sydney Local Health District, Sydney, NSW, Australia
- Department of Neurology, Division of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
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Strbian D, Tsivgoulis G, Ospel J, Räty S, Cimflova P, Georgiopoulos G, Ullberg T, Arquizan C, Gralla J, Zeleňák K, Hussain S, Fiehler J, Michel P, Turc G, Van Zwam W. European stroke organisation and European society for minimally invasive neurological therapy guideline on acute management of basilar artery occlusion. Eur Stroke J 2024:23969873241257223. [PMID: 38752743 DOI: 10.1177/23969873241257223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1%-2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five ESMINT) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements. First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (albeit in small numbers) in IVT trials. Non-randomised studies of IVT-only cohorts showed high proportion of favourable outcomes. Expert Consensus suggests using IVT up to 24 h unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared to BMT alone within 6 and 6-24 h from last seen well. In both time windows, we observed a different effect of treatment depending on (a) the region where the patients were treated (Europe vs. Asia), (b) on the proportion of IVT in the BMT arm, and (c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with NIHSS below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT + BMT over BMT alone (i.e. based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT + BMT over BMT alone in proximal and middle locations of BAO compared to distal location. While recommendations for patients without extensive early ischaemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischaemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 h after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty).
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Affiliation(s)
- Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Georgios Tsivgoulis
- Second Department of Neurology, 'Attikon' University Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Johanna Ospel
- Neuroradiology, Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Silja Räty
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Petra Cimflova
- Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Georgios Georgiopoulos
- Department of Physiology, School of Medicine, University of Patras, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Teresa Ullberg
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund and Malmö, Malmö, Sweden
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, INSERM U1266, Montpellier, France
| | - Jan Gralla
- Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | | | - Patrik Michel
- Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Bâtiment Hospitalier Principal, Lausanne, Switzerland
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, INSERM U1266, Université Paris Cité, FHU NeuroVasc, Paris, France
| | - Wim Van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Černík D, Ospalík D, Šaňák D, Cihlář F. Repeated Intravenous Thrombolysis in Patients with Recurrent Ischemic Stroke in the Vertebrobasilar Territory. Case Rep Neurol 2021; 13:510-514. [PMID: 34720955 PMCID: PMC8460951 DOI: 10.1159/000518193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Acute ischemic vertebrobasilar stroke (AIVBS) is usually associated with poor outcome and prognosis and in case of basilar artery occlusion (BAO) with high mortality. Intravenous thrombolysis (IVT), as a standard recanalization therapy of acute ischemic stroke (IS) within first 4.5 h, can be administrated beyond this therapeutic time window in case of symptomatic BAO. Repeated IVT is generally contraindicated in case of early recurrent IS, despite a risk of poor outcome or death after recurrent IS. The aim was to present 2 cases of repeated IVT for recurrent AIVBS and discuss specific situations where repeated IVT may be considered. Up to now, repeated IVT has been reported only in recurrent stroke in anterior circulation.
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Affiliation(s)
- David Černík
- Department of Neurology, Comprehensive Stroke Center, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czechia
| | - Dušan Ospalík
- Department of Neurology, Comprehensive Stroke Center, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czechia
| | - Daniel Šaňák
- Department of Neurology, Comprehensive Stroke Center, Palacký University Medical, School and Hospital, Olomouc, Czechia
| | - Filip Cihlář
- Department of Radiology, Masaryk Hospital, Faculty of Health Studies, J.E. Purkinje University, KZ a.s., Ústí nad Labem, Czechia
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Chen PM, Pirastehfar M, Hailey L, Morton M, Rapp KS, Agrawal K, Modir R, Meyer D, Meyer BC. PREMISE: Posterior Circulation Results Comparing Embolectomy to Medical Intervention in Stroke Emergencies. Cureus 2019; 11:e6000. [PMID: 31807387 PMCID: PMC6876905 DOI: 10.7759/cureus.6000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 01/01/2023] Open
Abstract
Background Intravenous (IV) tissue plasminogen activator (rt-PA) is a proven therapy for stroke in the acute treatment window. Recent published data has shown efficacy for embolectomy for acute ischemic strokes within up to six, 16 and 24 hours in the anterior circulation but there is no guideline for optimal therapy for patients with posterior circulation stroke, specifically basilar artery occlusion (BAO) outside the standard IV rt-PA treatment window. Aim To evaluate differences in outcomes between maximal medical treatment versus thrombectomy in BAO. Method We retrospectively evaluated prospectively collected acute stroke code patients from our stroke registry from 7/2004 to 7/2016. Patients who received IV rt-PA were excluded. Patients with evidence of posterior circulation ischemia and a hyper dense artery sign on initial non-contrast CT were included as a surrogate for direct vessel data before 2014. Patients after 9/2014 were selected by evidence of BAO on vessel imaging. All patients were categorized either as endovascular therapy or standard medical treatment alone. Demographics, hospital discharge location and Modified Rankin Scale (mRS) at 90 days were compared. Two-sample t-test and Fisher's exact test compared continuous and categorical variables across groups respectively. Results A total of 18 patients were included (three embolectomy and 15 medical therapy only). There were no significant differences in demographic data (age, gender, race, ethnicity, blood pressure, diabetes mellitus, hypertension, atrial fibrillation, tobacco use, alcohol use and initial NIHSS). Results for outcome and efficacies showed no statistical difference between medical management and endovascular intervention for functional outcome mRS (0-3) at 90 days (p = 0.2) and discharge location of home/inpatient rehabilitation vs other locations (p = 0.52). Conclusions Our single-center review showed the expected transition from predominantly medically treated posterior circulation BAOs, to a mixed pattern including embolectomy. Although the sample size was small, this study also illustrates the lack of clear efficacy data for optimal treatment strategies, and the ongoing treatment challenges in posterior circulation stroke population in a population of patients outside the rt-PA window.
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Affiliation(s)
- Patrick M Chen
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Mohsen Pirastehfar
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Lovella Hailey
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Melissa Morton
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Karen S Rapp
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Kunal Agrawal
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Royya Modir
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Dawn Meyer
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Brett C Meyer
- Neurosciences, University of California San Diego School of Medicine, San Diego, USA
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Dorňák T, Král M, Šaňák D, Kaňovský P. Intravenous Thrombolysis in Posterior Circulation Stroke. Front Neurol 2019; 10:417. [PMID: 31080436 PMCID: PMC6497784 DOI: 10.3389/fneur.2019.00417] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/05/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS). PCIS is a clinical syndrome associated with ischemia-related changes in the territory of the posterior circulation arteries. Embolism is the most common stroke mechanism in posterior circulation. PCIS represents 12–19% of all IVT-treated strokes. Methods and Results: We searched the PubMed database for assessments of intracerebral hemorrhage (ICH) and clinical outcome in PCIS patients treated with IVT. ICH occurs in 0–6.9% of posterior ischemic stroke depending on the definition of symptomatic ICH, and any ICH in 17–23.4% of posterior ischemic stroke. For patients with PCIS, 38–49% have a favorable outcome (mRS 0–1) after IVT. Better clinical outcomes occur more often in patients with PCIS than in those with ACIS. The mortality rate among PCIS patients treated with IVT ranges from 9 to 19%; it does not differ significantly between PCIS and ACIS. Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset.
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Affiliation(s)
- Tomáš Dorňák
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
| | - Michal Král
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
| | - Daniel Šaňák
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
| | - Petr Kaňovský
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
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Dorňák T, Král M, Hazlinger M, Herzig R, Veverka T, Buřval S, Šaňák D, Zapletalová J, Antalíková K, Kaňovský P. Posterior vs. anterior circulation infarction: demography, outcomes, and frequency of hemorrhage after thrombolysis. Int J Stroke 2015; 10:1224-8. [PMID: 26310390 DOI: 10.1111/ijs.12626] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intravenous thrombolysis is considered to be the standard specific reperfusion therapy in acute ischemic stroke in both anterior and posterior cerebral circulation. AIMS Our aim was to evaluate the 90-day outcome and rate of intracranial hemorrhage after recombinant tissue plasminogen activator administration in posterior circulation stroke and to compare the intracranial hemorrhage risk for posterior circulation stroke and anterior circulation stroke. METHODS The set consisted of 877 consecutive acute ischemic stroke patients (777 anterior circulation stroke; 100 posterior circulation stroke) who underwent intravenous thrombolysis with recombinant tissue plasminogen activator in a standard dose of 0·9 mg/kg. The role of following factors was assessed: presenting characteristics, intracranial hemorrhage classification according to ECASS I, mortality, and 90-day clinical outcome assessed using the modified Rankin scale. RESULTS Good clinical outcomes (modified Rankin scale 0-2) were noted in 59% of posterior circulation stroke patients, with a mortality rate of 19%. Intracerebral hemorrhage was significantly less frequent in posterior circulation stroke than in anterior circulation stroke patients (5·1 vs. 17·2%; P = 0·002). The risk of large hemorrhage (parenchymal hematoma 1 and 2) was 5·2 times higher in anterior circulation stroke patients (P = 0·007). The following additional statistically significant differences were found between posterior circulation stroke and anterior circulation stroke patients: median age, male gender, presence of atrial fibrillation, hyperlipidemia, median time to treatment, and median blood glucose level on admission. CONCLUSIONS Our study suggests that posterior circulation stroke is associated with a lower risk of intracranial hemorrhage than anterior circulation stroke is.
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Affiliation(s)
- Tomáš Dorňák
- Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Michal Král
- Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Hazlinger
- Department of Radiology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Roman Herzig
- Department of Neurology, Palacký University, Olomouc, Czech Republic
| | - Tomáš Veverka
- Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Stanislav Buřval
- Department of Radiology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Daniel Šaňák
- Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Medical Biophysics, Palacký University, Olomouc, Czech Republic
| | - Kristýna Antalíková
- Department of Radiology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Kaňovský
- Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
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Dorňák T, Herzig R, Kuliha M, Havlíček R, Školoudík D, Šaňák D, Köcher M, Procházka V, Lacman J, Charvát F, Krajina A, Krajíčková D, Král M, Veverka T, Roubec M, Hajduková L, Zapletalová J. Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial. Clin Radiol 2015; 70:e20-7. [PMID: 25703459 DOI: 10.1016/j.crad.2015.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/25/2014] [Accepted: 01/16/2015] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the safety and efficacy of multimodal endovascular treatment (EVT) of acute basilar artery occlusion (BAO), including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT], to compare particular EVT techniques and identify predictors of clinical outcome. MATERIALS AND METHODS This retrospective, multi-centre study comprised 72 acute ischaemic stroke patients (51 males; mean age 59.1 ± 13.3 years) with radiologically confirmed BAO. The following data were collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, localization of occlusion, time to therapy, recanalization rate, post-treatment imaging findings. Thirty- and 90-day outcomes were evaluated using the modified Rankin scale with a good clinical outcome defined as 0-3 points. RESULTS Successful recanalization was achieved in 94.4% patients. Stepwise binary logistic regression analysis identified the presence of arterial hypertension (OR = 0.073 and OR = 0.067, respectively), National Institutes of Health Stroke Scale (NIHSS) at the time of treatment (OR = 0,829 and OR = 0.864, respectively), and time to treatment (OR = 0.556 and OR = 0.502, respectively) as significant independent predictors of 30- and 90-day clinical outcomes. CONCLUSION Data from this multicentre study showed that multimodal EVT was an effective recanalization method in acute BAO. Bridging therapy shortens the time to treatment, which was identified as the only modifiable outcome predictor.
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Affiliation(s)
- T Dorňák
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - R Herzig
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurosurgery, Military University Hospital Prague, Czech Republic.
| | - M Kuliha
- Comprehensive Stroke Center, Department of Neurology, Ostrava University and University Hospital Ostrava, Czech Republic
| | - R Havlíček
- Comprehensive Stroke Center, Department of Neurology, Military University Hospital Prague, Czech Republic
| | - D Školoudík
- Department of Neurology, Palacký University, Olomouc, Czech Republic
| | - D Šaňák
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - M Köcher
- Comprehensive Stroke Center, Department of Radiology, Palacký University and University Hospital Olomouc, Czech Republic
| | - V Procházka
- Comprehensive Stroke Center, Department of Radiology, Ostrava University and University Hospital Ostrava, Czech Republic
| | - J Lacman
- Comprehensive Stroke Center, Department of Radiology, Military University Hospital Prague, Czech Republic
| | - F Charvát
- Comprehensive Stroke Center, Department of Radiology, Military University Hospital Prague, Czech Republic
| | - A Krajina
- Comprehensive Stroke Center, Department of Radiology, Charles University and University Hospital Hradec Králové, Czech Republic
| | - D Krajíčková
- Comprehensive Stroke Center, Department of Neurology, Charles University and University Hospital Hradec Králové, Czech Republic
| | - M Král
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - T Veverka
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - M Roubec
- Comprehensive Stroke Center, Department of Neurology, Ostrava University and University Hospital Ostrava, Czech Republic
| | - L Hajduková
- Comprehensive Stroke Center, Department of Neurology, Military University Hospital Prague, Czech Republic
| | - J Zapletalová
- Department of Medical Biophysics, Palacký University Olomouc, Czech Republic
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