Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Lee, Woojin; Jung, Keun‐Hwa; Ryu, Young Jin; Kim, Jeong‐Min; Chu, Kon; Kim, Manho; Lee, Sang Kun; Sohn, Chul‐Ho; Roh, Jae Kyu

doi:10.1002/acn3.536

Cited by 27 publications

(31 citation statements)

References 31 publications

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“…Artery-to-artery thromboembolism was the most common mechanism of infarction in ISBAS. Previous studies describe in situ atherosclerotic thrombosis associated with poorer outcomes,4 while other studies used the classic Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification criteria and did not find any significant relationship 23–26. Of note, these studies did not exclude patients with vertebrobasilar disease, and artery-to-artery thromboembolic events from vertebral artery atheromatous plaque played an important role in stroke mechanism.…”

Section: Discussionmentioning

confidence: 98%

“…The advent of new endovascular techniques and devices has broadened treatment options for patients with atherosclerotic disease in the posterior circulation. This has sparked the interest to better characterise the haemodynamics, presence of perforators and stroke mechanisms in the posterior circulation, specifically the basilar artery (BA) 3 4. In order to adequately study the potential of new endovascular procedures, it is necessary to better understand the natural history and stroke mechanisms of atherosclerotic lesions in different locations.…”

Section: Introductionmentioning

confidence: 99%

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Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

et al. 2019

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BackgroundWhile diffuse atherosclerotic disease affecting the posterior circulation has been described extensively, the prevalence, natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis (ISBAS) remain unknown.MethodsWe reviewed our prospective institutional database to identify patients with ≥50% symptomatic basilar artery (BA) stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries. Stroke mechanism, collateral circulation, and degree and length of stenosis were analysed. The primary outcome was time from index event to new transient ischaemic attack (TIA), acute ischaemic stroke (AIS) or death. Other outcome variables included modified Rankin Scale (mRS) score on discharge and last follow-up.ResultsOf 6369 patients with AIS/TIA, 91 (1.43%) had ISBAS. Seventy-three (80.2%) patients presented with AIS and 18 (19.8%) with TIA. Twenty-nine (31.9%) were women and the median age was 66.8±13.6 years. The mean follow-up time was 2.7 years. The most common stroke mechanism was artery-to-artery thromboembolism (45.2%), followed by perforator occlusion (28.7%) and flow-dependent/hypoperfusion (15.1%). The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3–6 on discharge (78.3±14.3 vs 86.9±14.5, p=0.007). Kaplan-Meier curves showed higher recurrence/death rates in patients with ≥80% stenosis, mid-basilar location and poor collateral circulation. Approximately 13% of patients with ISBAS presented with complete BA occlusion.ConclusionISBAS is an uncommon (1.43%) cause of TIA and AIS. Men in their 60s are mostly affected, and artery-to-artery embolism is the most common stroke mechanism. Mid-basilar location, ≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

et al. 2019

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“…Prodrome was defined as stroke-associated symptoms before index events (coma, quadriplegia, and locked-in syndrome) of VBAO ( 16 ). Occlusion mechanisms were diagnosed according to established criteria ( 7 ), and ISAT was defined according to the following criteria: (a) detection of moderate to severe (≥50%) stenosis or stenosis with significant distal flow impairment at the occluded segment when successful reperfusion was achieved; (b) transient visualization of eccentric plaque contour or a recurrent re-occlusion tendency when reperfusion was unsuccessful. The embolism mechanism was diagnosed when there was no evidence of ISAT, including (a) complete recanalization without residual stenosis in occluded segments and (b) have established source of embolism with or without reperfusion ( 8 ).…”

Section: Methodsmentioning

confidence: 99%

“…Diagnoses of ISAT were independently finished by two experienced neurologists (MZ and MW) following the flowchart in the published reference ( 7 ), and disparities were solved by an experienced neuro-interventionalist (RL). Interobserver agreement for ISAT was assessed using Cohen's kappa coefficient (Cohen κ).…”

Section: Methodsmentioning

confidence: 99%

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A Pre-Interventional Scale to Predict in situ Atherosclerotic Thrombosis in Acute Vertebrobasilar Artery Occlusion Patients

Zha

Huang

et al. 2021

Front. Neurol.

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Background and Purpose: Determining the occlusion mechanism before endovascular treatment (EVT) is of great significance for acute large vessel occlusion patients. We aimed to develop and validate a simple pre-EVT scale with readily available variables for predicting in situ atherosclerotic thrombosis (ISAT) in acute vertebrobasilar artery occlusion (VBAO) patients.Materials and Methods: Consecutive patients were retrieved from Nanjing Stroke Registry Program between January 2014 and December 2019 as a derivation cohort. Anonymous data of consecutive patients between January 2014 and December 2019 were collected from another comprehensive stroke center as an external validation cohort. Demographics, medical histories, and clinical characteristics were collected. ISAT was defined according to the following criteria: (a) detection of moderate to severe (≥50%) stenosis or stenosis with significant distal flow impairment at the occluded segment when successful reperfusion was achieved; (b) transient visualization of eccentric plaque contour or a recurrent re-occlusion tendency when reperfusion was unsuccessful. Logistic regression was taken to develop a predictive scale. The performance of the scale was assessed by area under the receiver operating characteristic curve (AUC) and Hosmer–Lemeshow test.Results: ISAT was observed in 41 of 95 (43.2%) patients included in the derivation cohort. The ISAT predictive scale consisted of three pre-interventional predictors, including the history of hypertension, atrial fibrillation rhythm, and baseline serum glucose level ≥7.55 mmol/L. The model depicted acceptable calibration (Hosmer–Lemeshow test, P = 0.554) and good discrimination (AUC, 0.853; 95% confidence interval, 0.775–0.930). The optimal cutoff value of the ISAT scale was 1 point with 95.1% sensitivity, 64.8% specificity, and 77.9% accuracy. In the validation cohort, the discrimination ability was still promising with an AUC value of 0.800 (0.682–0.918).Conclusion: The three-item scale comprised of the history of hypertension, atrial fibrillation rhythm, and dichotomous serum glucose level had a promising predictive value for ISAT before EVT in acute VBAO patients.

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Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry

Zi¹,

Qiu²,

Wu³

et al. 2020

JAMA Neurol

261

222

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Writing Group for the BASILAR Group IMPORTANCE Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT.OBJECTIVE To evaluate the association between EVT and clinical outcomes of patients with acute BAO. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. MAIN OUTCOMES AND MEASURESThe primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality.RESULTS A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI,; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001).CONCLUSIONS AND RELEVANCE Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.

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Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Cited by 27 publications

References 31 publications

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

A Pre-Interventional Scale to Predict in situ Atherosclerotic Thrombosis in Acute Vertebrobasilar Artery Occlusion Patients

Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry

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