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Clinical Outcomes of Patients with Acute Basilar Artery Occlusion in Brazil: An Observational Study

Abstract:

Background Intravenous thrombolysis (IVT) and endovascular therapy (EVT) were proven safe and effective for anterior circulation proximal occlusions. However, the most appropriate recanalization strategy in patients with acute basilar artery occlusion (BAO) is still controversial. This study aimed to assess outcomes of patients with BAO at an academic stroke center in Brazil. Methods This is a retrospective analysis of consecutive patients with BAO from a prospective stroke registry at Ribeirão Preto Medical School. Primary outcomes were mortality and favorable outcome (modified Rankin score [mRS] ≤3) at 90 days. After univariate analyses, multivariate logistic regressions were used to identify independent pbkp_redictors of primary outcomes. Results Between August 2004 and December 2015, 63 (65% male) patients with BAO and median National Institutes of Health Stroke Scale (NIHSS) score of 31 (interquartile range: 19-36) were identified. Twenty-nine (46%) patients received no acute recanalization therapy, 15 (24%) received IVT, and 19 (30%) received EVT (68% treated with stent retrievers). Twenty-four (83%) patients treated conservatively died, and only 2 (7%) achieved an mRS less than or equal to 3. Among patients treated with acute recanalization therapies, 15 (44%) died, and 9 (26.5%) had a favorable outcome. On multivariate analysis, baseline systolic blood pressure (odds ratio [OR] =.97; 95% confidence interval [CI]:.95-0.99; P =.023), posterior circulation Alberta Stroke Program Early CT score (OR =.62; 95% CI:.41-0.94; P =.026), and successful recanalization (OR =.18; 95% CI:.04-0.71; P =.015) were independent pbkp_redictors of lower mortality. Baseline NIHSS (OR = 1.40; 95% CI: 1.08-1.82; P =.012), prior use of statins (OR =.003; 95% CI:.001-0.28; P =.012), and successful recanalization (OR =.05; 95% CI:.001-0.27; P =.009) were independent pbkp_redictors of favorable outcome. There was no significant difference between the IVT group and the EVT group on primary outcomes. Conclusions BAO is associated with high morbidity and mortality in Brazil. Access to acute recanalization therapies may decrease mortality in those patients.