Comparison of endovascular treatment versus conservative medical treatment in patients with acute basilar artery occlusion

Vasc Endovascular Surg. 2013 Aug;47(6):429-37. doi: 10.1177/1538574413488458. Epub 2013 May 19.

Abstract

Introduction: Basilar artery occlusion (BAO) causes mortality up to 90%.

Methods: A total of 99 patients with BAO received either endovascular (endovascular mechanical recanalization and/or intra-arterial with optional intravenous thrombolysis [IVT] as bridging concept) or conservative medical treatment (IVT and/or medical oral therapy). Outcome parameters were measured in accordance with the thrombolysis in cerebral infarction (TICI), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) scores.

Results: In all, 78% underwent endovascular and 22% conservative medical treatment. The NIHSS at admission was 20 in both the groups. Postprocedurally, 36% (95% confidence interval: 26%-48%) of the endovascular group and 9% (21%-64%) of the conservative group reached TICI 3 (P = .017). In all, 30% of the endovascular group and 9% of the conservative group were documented with TICI 2b (P = .057). At 90 days follow-up, 45% (31%-60%) of the endovascular-treated patientsand no patient (0%-25%) of the conservative-treated group reached mRS ≤2 (P = .012).

Conclusion: Endovascular treatment of BAO provides a better chance to survive this severe condition with good clinical outcome.

Keywords: BAO; basilar artery occlusion; endovascular treatment; stroke; thrombectomy.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Angiography, Digital Subtraction
  • Arterial Occlusive Diseases / diagnosis
  • Arterial Occlusive Diseases / mortality
  • Arterial Occlusive Diseases / therapy*
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Cerebral Angiography / methods
  • Disability Evaluation
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Female
  • Humans
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / mortality
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vertebrobasilar Insufficiency / diagnosis
  • Vertebrobasilar Insufficiency / therapy*

Substances

  • Cardiovascular Agents