AUTHOR=Ritvonen Juhani , Sairanen Tiina , Silvennoinen Heli , Virtanen Pekka , Salonen Oili , Lindsberg Perttu J. , Strbian Daniel 

TITLE=Comatose With Basilar Artery Occlusion: Still Odds of Favorable Outcome With Recanalization Therapy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.665317

DOI=10.3389/fneur.2021.665317

ISSN=1664-2295

ABSTRACT=Background:
30-60% of patients with basilar artery occlusion (BAO) present with coma, which is often considered as a hallmark of poor prognosis. 
Aim: 
To examine factors that will help predicting outcome in patients with BAO being comatose on admission. 
Methods:
312 patients with angiography-proven BAO were analyzed. Coma was assessed as Glasgow Coma Scale (GCS) of 8 or impaired level of consciousness ascertained in the medical records. Outcome was evaluated with modified Rankin Scale (mRS) over a phone call at three months. 53 patients were excluded due to inadequate data of the level of consciousness. 
Results:
103/259 (39.8%) of BAO patients presented comatose on admission. Factors associated with acute coma were higher age, coronary artery disease, convulsions, extent of early ischemia by posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS)<8, absence of patent posterior collateral vasculature and occlusion over multiple segments of BA. 21/103 (20.4%) of comatose patients had favorable outcome (mRS 0-3) and 12/103 (11.7%) had good outcome (mRS 0-2). Factors associated with favorable outcome in comatose BAO patients were younger age (p=0.010), less extensive baseline ischemia (p=0.027), recanalization (p=0.013) and avoiding symptomatic intracranial hemorrhage (sICH) (p=0.038). Factors associated with the poorest outcome or death (mRS 5-6) were older age (p=0.001), diabetes (p=0.022), atrial fibrillation (p=0.016), lower median GCS (4 [IQR 3.6] vs 6 [5-8]; p=0.006), pc-ASPECTS <8 (p=0.003), unsuccessful recanalization (p=0.006) and sICH (p=0.010). Futile recanalization (mRS 4-6) was significantly more common in comatose patients (49.4% vs 18.5%, p<0.001).  

Conclusions:
One in five BAO patients with acute coma had a favorable outcome. Older patients with cardio- vascular comorbidities and already existing ischemic lesions before reperfusion therapies tended to have poor prognosis, especially if no recanalization is achieved and sICH occurred.