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Jung S, Mono ML, Fischer U, Galimanis A, Findling O, De Marchis GM, Weck A, Nedeltchev K, Colucci G, Mordasini P, Brekenfeld C, El-Koussy M, Gralla J, Schroth G, Mattle HP, Arnold M. Three-month and long-term outcomes and their predictors in acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke 2011; 42:1946-51. [PMID: 21546481 DOI: 10.1161/strokeaha.110.606038] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Intra-arterial thrombolysis can be used for treatment of basilar artery occlusion. Predictors of outcome before initiation of treatment are of special interest. METHODS From 1992 to 2010, we treated 106 consecutive patients with basilar artery occlusion with intra-arterial thrombolysis. Baseline characteristics, treatment, clinical course, and 3-month and long-term outcomes (≥12 months) were assessed. Outcome parameters were vessel recanalization after treatment, complications, modified Rankin scale (mRS) score, and mortality after 3 months and in the long-term. RESULTS At 3 months, clinical outcome was good (mRS score, 0-2) in 33.0% of the patients and moderate (mRS score, 3) in 11.3%. Mortality was 40.6%. Partial or complete recanalization was achieved in 69.8% of the patients, and symptomatic intracranial hemorrhage occurred in 1 patient (0.9%). Between 3-month and long-term follow-up, 22 survivors (40.8%) showed clinical improvement of at least 1 point on the mRS score, 29 (53.7%) were functionally unchanged, and 3 (5.7%) showed functional worsening (P<0.0001). Multivariate analysis identified diabetes as a predictor of poor vessel recanalization (P=0.028). Low baseline National Institutes of Health Stroke Scale score was identified as a predictor of good or moderate clinical outcome (P<0.0001) and survival (P=0.001) at 3 months, and younger age was identified as an additional predictor of survival (P=0.012). For prediction of long-term clinical outcome, age was also an independent predictor (P=0.018). CONCLUSIONS In our series, intra-arterial thrombolysis as treatment of basilar artery occlusion was safe. National Institutes of Health Stroke Scale score at admission and age were identified as predictors of outcome, and these predictors should be considered for treatment allocation in future randomized trials.
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Affiliation(s)
- Simon Jung
- Department of Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland
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Goldmakher GV, Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Halpern EF, Chou MJ, Biagini T, Smith WS, Harris GJ, Dillon WP, Gonzalez RG, Koroshetz WJ, Lev MH. Hyperdense Basilar Artery Sign on Unenhanced CT Predicts Thrombus and Outcome in Acute Posterior Circulation Stroke. Stroke 2009; 40:134-9. [DOI: 10.1161/strokeaha.108.516690] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory V. Goldmakher
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Erica C.S. Camargo
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Karen L Furie
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Aneesh B. Singhal
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Luca Roccatagliata
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Elkan F. Halpern
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Maggie J. Chou
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Trese Biagini
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Wade S. Smith
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Gordon J. Harris
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - William P. Dillon
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - R. Gilberto Gonzalez
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Walter J. Koroshetz
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
| | - Michael H. Lev
- From Departments of Radiology (G.V.G., L.R., E.F.H., G.J.H., R.G.G., M.H.L.) and Neurology (E.C.S.C., K.L.F., A.B.S., M.J.C., W.J.K.), Massachusetts General Hospital; Boston, Mass; Departments of Neurology (T.B., W.S.S.), and Radiology (W.P.D.), University of California at San Francisco, San Francisco, Calif
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