Basilar artery occlusion

Mattle, Heinrich; Arnold, Marcel; Lindsberg, Perttu J.; Schonewille, Wouter J.; Schroth, Gerhard

doi:10.1016/s1474-4422(11)70229-0

Cited by 471 publications

(470 citation statements)

References 94 publications

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“…The outcome and mortality associated with BAO are worse than those associated with anterior circulation stroke 1, 2, 3. Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke,4 the effectiveness and safety of modern thrombectomy remains uncertain for patients with acute BAO.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

123

117

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BackgroundDespite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.Methods and ResultsThis study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique.ConclusionsEndovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO.

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Section: Introductionmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

123

117

View full text Add to dashboard Cite

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“…The incidence of BAS in adults is unknown; however, the incidence of BAO is estimated at one per 100 000 a year. 1 Adult mortality rates with BAO are 75 to 90%, supporting aggressive treatments including endovascular interventions. However, in children, there are only limited data on BAS or BAO outcomes.…”

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confidence: 99%

Basilar artery strokes in children: good outcomes with conservative medical treatment

Lagman-Bartolome

Pontigon

Moharir

et al. 2013

Develop Med Child Neuro

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Aim To describe outcomes and outcome predictors in childhood basilar artery stroke (BAS). Method We prospectively enrolled children with BAS with or without basilar artery occlusion (BAO) in the Toronto Children's Stroke Registry from 1992 to 2009. We assessed presenting features and outcomes including Pediatric Stroke Outcome Measure scores. Results Among 578 children with acute arterial ischemic stroke, 27 had BAS (4.6% including neonates, 6% excluding neonates). Twenty‐four (14 males, 10 females) children met study criteria (mean age at stroke was 8y 10mo; range 0–17y). Eleven children had BAO. Aspirin or anticoagulation was given to 15 children. None received tissue plasminogen activator or endovascular treatments. At mean follow‐up (3y 2mo, range 1mo–11y 8mo), 12 had a ‘good outcome’ (seven normal, five insignificant deficit) and 12 had ‘poor outcome’ (10 moderate or severe deficit, two acute deaths). Larger infarct size (≥50% of axial brainstem diameter) independently predicted poor outcome (p=0.02; odds ratio 21.2, 95% confidence interval 1.6–274.9) but not BAO, altered level of consciousness, or age. Interpretation Compared with adults, in childhood BAS death is rare and survivors frequently have good outcomes. Aggressive endovascular interventions may not be justifiable in this population.

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“…Interestingly, testing both for neck stiffness – after careful exclusion of preceding trauma – and the Babinski sign are highly recommended by our experts. This reflects the importance of using highly specific tests (Isaza Jaramillo et al., 2014; Nakao, Jafri, Shah, & Newman, 2014; van de Beek et al., 2004) that recognize conditions requiring prompt initiation of treatment (Auburtin et al., 2006; Möhlenbruch et al., 2014), although mixed results regarding the sensitivity of each sign have been reported (Isaza Jaramillo et al., 2014; Mattle et al., 2011). …”

Section: Discussionmentioning

confidence: 99%

“…However, severe neurological diseases such as meningitis, subarachnoid hemorrhage, or basilar artery occlusion (including top of the basilar syndrome) often present with coma, either without focal asymmetric deficits, or with bilateral symmetric deficits (Caplan, 1980; Mattle, Arnold, Lindsberg, Schonewille, & Schroth, 2011; Schwarz, Egelhof, Schwab, & Hacke, 1997). Furthermore, they are often difficult to detect in native cerebral CT scans.…”

Section: Introductionmentioning

confidence: 99%

The essential neurological examination of the unconscious patient in the emergency room

2018

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ObjectiveTo determine whether neurologists with long‐term experience in the emergency room are in general agreement about the essential components of the neurological examination (NE) used on unconscious patients in whom an obvious cause for coma is lacking.MethodsWe surveyed 31 board‐certified practicing neurologists who regularly examine unconscious patients in the emergency room and asked them to list the specific components of the NE that they would normally choose to apply in at least 80% of cases.ResultsTwenty‐seven neurologists rated 24 of 38 items as essential steps of the neurological examination of the unconscious patient, with a high level of agreement amongst survey participants.ConclusionsThere was a high degree of consensus amongst the neurologists surveyed about which steps are essential for the NE of the unconscious patient. These findings provide an important source of validation for teaching this particular NE to medical students, as well as nonneurologists working in an emergency setting.

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Basilar artery occlusion

Cited by 471 publications

References 94 publications

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Basilar artery strokes in children: good outcomes with conservative medical treatment

The essential neurological examination of the unconscious patient in the emergency room

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