Endovascular Treatment of Acute Basilar Artery Occlusion (P4.217)

OBJECTIVE: To evaluate safety and efficacy of multimodal endovascular treatment (EVT) of acute basilar artery occlusion (BAO), including bridging therapy (intravenous thrombolysis [IVT] with subsequent EVT). BACKGROUND: Acute ischemic stroke (AIS) caused by BAO is often associated with a severe and persistent neurological deficit and a high mortality rate. Nevertheless, the most effective therapeutic approach has not been established yet. DESIGN/METHODS: In the retrospective study, the set consisted of 62 AIS patients (46 males; mean age 58.7 ± 12.5 years) with radiologically confirmed BAO. Following data was collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, time to therapy, recanalization rate (with successful recanalization defined as Thrombolysis in Cerebral Infarction score 2-3), post-treatment imaging findings. 30-day and 90-day outcome was assessed using modified Rankin scale (mRS) with good clinical outcome defined as 0-3 points. RESULTS: The mean time from symptoms onset to treatment was 5.5±3.9 hours and to EVT 6.4±3.8 hours. Successful recanalization was achieved in 91.9% patients. Stepwise binary logistic regression analysis identified presence of arterial hypertension (OR=0.121, 95% CI: 0.028-0.531; p=0.005) and treatment type - the use of bridging therapy (OR=6.64, 95% CI: 1.56-28.1; p=0.01) as significant independent predictors of good 30-day outcome and, time from symptoms onset to treatment (OR=0.714, 95% CI: 0.543-0.939; p=0.016) ) as significant independent predictor of good 90-day outcome. CONCLUSIONS: Data in this series showed that multimodal EVT was an effective recanalization method of acute BAO. Bridging therapy was associated with better 30-day clinical outcome. EVT should be started as soon as possible after IVT and not considered only as a rescue strategy. Study Supported by: the grants of the Internal Grant Agency of Ministry of Health of the Czech Republic number NT/11046-6/2010, NT/11386-5/2010, and NT/13498-4/2012, and by the grant project number CZ.1.05/2.1.00/01.0030. Disclosure: Dr. Herzig has received personal compensation for activities with Bayer Pharmaceuticals Corp., and Gedeon Richter. Dr. Dornak has nothing to disclose. Dr. Skoloudik has nothing to disclose. Dr. Sanak has received personal compensation for activities with Boehringer Ingelheim Pharmaceuticals Inc. as a scientific advisory board member and speaker. Dr. Kuliha has nothing to disclose. Dr. Roubec has nothing to disclose. Dr. Havlicek has nothing to disclose. Dr. Hajdukova has nothing to disclose. Dr. Kocher has nothing to disclose. Dr. Prochazka has nothing to disclose. Dr. Lacman has nothing to disclose. Dr. Charvat has nothing to disclose. Dr. Kral has nothing to disclose. Dr. Veverka has nothing to disclose. Dr. Zapletalova has nothing to disclose.