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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00923

Predictors of outcome after endovascular thrombectomy in acute basilar artery occlusion and the 6 hour time window to recanalization

 Johannes Ravindren1*, Marta Aguilar Pérez1,  Victoria Hellstern1, Pervinder Bhogal2, Hansjörg Bäzner3 and  Hans Henkes1
  • 1Klinik für Neuroradiologie, Klinikum Stuttgart, Germany
  • 2Department of Neuroradiology, St Bartholomew's Hospital, United Kingdom
  • 3Neurologische Klinik, Klinikum Stuttgart, Germany

Abstract
Background and Purpose: Decision algorithms for large vessel occlusions in the anterior circulation remain unconfirmed for acute basilar artery occlusion (aBAO). The aim of this study was to investigate procedural parameters, patient characteristics, functional outcome and survival in dependency of the time window to recanalization from symptom onset. Furthermore predictors of outcome were identified.
Materials and Methods: Retrospectively 231 patients with aBAO treated with endovascular
treatment (EVT) between November 2008 and February 2019 were identified in a
prospectively maintained single center stroke database. Baseline characteristics such as age, cardiovascular risk factors, NIHSS at admission, pre interventional PC-ASPECTS, periprocedural parameters such as time to recanalization, duration of treatment, extent of reperfusion, collateral status and occlusion patterns, as well as postinterventional 24 hour NIHSS and postinterventional ICH were evaluated. Target variables were mRS 90 days and mortality over 90 days.
Results: Good outcome (mRS 0-2) was attained in 29, 5% (n=68) of patients, overall mortality was 36.8% (n=85). In mulitivariate analyses Patients with time to reperfusion beyond 6 hours had a more than half fold decreased chance of good outcome (OR 0.47 95% CI (0.23-0.95) p<.05). The odds for good outcome were reduced by almost 2/3 if post interventional imaging revealed intracerebral hemorrhage (OR 0.28 95% CI (0.08-0.98)). Unfavorable outcome was noted in 100% (n=14) of patients with symptomatic ICH.
Risk for death was reduced by more than 80% if collaterals were present (0.16 95% CI (0.03-0.87) and if recanalization was successful (TICI 2b-3) (OR 0.19 95% CI (0.05-0.78)).
The odds for survival were 5 fold higher in patients with no postinterventional hemorrhages present (OR 5.35 95% CI (2.2-1.58)).

Conclusion: This study might contribute to explaining the ambiguous findings regarding the validity of the 6 hour time window in aBAO, suggesting that collateral status impacts the odds of survival in the time window to recanalization beyond 6 hours. In our study recanalization within 6 hours from symptom onset was associated with good outcome. Successful recanalization (TICI 2b-3a) was necessary for good outcome and survival, post interventional ICH was highly associated with unfavorable outcome. This might ease the decision making for EVT.

Keywords: Stroke, Posterior Circulation, Basilar artery occlusion, time window to treatment, Outcome

Received: 07 Mar 2019; Accepted: 09 Aug 2019.

Copyright: © 2019 Ravindren, Aguilar Pérez, Hellstern, Bhogal, Bäzner and Henkes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Johannes Ravindren, Klinik für Neuroradiologie, Klinikum Stuttgart, Stuttgart, Germany, johannesravindren@googlemail.com