Basilar Artery Thrombectomy Within 9 hrs Is Linked With Better Outcomes in Stroke Patients
Basilar artery occlusion (BAO) has long been recognized as an acute stroke syndrome with a poor prognosis. In a recent study, researchers reinforced that earlier treatment was associated with more favourable outcomes in patients with BAO. In other words, a longer time to treatment seems to have correlated with a higher risk of bleeding. The study findings were updated and published in the journal Neurology on November 30, 2021.
Faster time from onset to puncture (OPT) using endovascular therapy (EVT) in acute large-vessel occlusion of anterior circulation has been associated with better clinical outcomes. However, the relationship in acute basilar artery occlusion (BAO) is still not well delineated. Therefore, Dr Hong Fei Sang and his team conducted a study to characterize the association of onset to puncture time with clinical outcomes among patients with acute basilar artery occlusion receiving EVT in clinical practice.
The researchers analyzed 639 acute BAO patients receiving EVT from a nationwide registry of BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion study). The major outcome assessed was the favourable functional outcome (defined as modified Rankin Scale score 0-3) at 90 days. They also assessed functional independence (mRS 0–2), mortality, and symptomatic intracerebral haemorrhage.
Key findings of the study:
- Upon analysis, the researchers found that the treatment within 4–8 hours and 8–12 hours was associated with lower rates of favourable outcome (adjusted odds ratio, 0.63 and 0.47, respectively) compared with treatment within 4 hours.
- Upon restricted cubic spline regression analysis, they found that the OPT had L-shaped associations with favourable outcome and functional independence, with significant benefit loss throughout the first 9 hours, but noted that it appeared relatively flat.
- They noted that the odds of mortality increased relatively for OPT up to 9 hours but then levelled off.
- They observed no significant association between symptomatic intracerebral haemorrhage and OPT.
In short, the quicker a stroke is diagnosed and treated, the better recovery typically goes, and the more likely the person is to have a greater return of neurologic function.
The authors concluded, "Among patients with acute basilar artery occlusion in routine practice, earlier treatment with EVT was associated with better outcomes throughout the first 9 hours after onset, but the benefit may sustain unchanged afterwards."
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