A highly detrimental condition known as basilar artery occlusion (BAO) had no conclusive proof to direct treatment. The link between endovascular therapy (EVT) and better outcomes in anterior circulation with faster treatment time had been well known. However, no clear outline existed to show if the same association existed for patients with BAO. Between January 2015 and December 2019, researchers accumulated individual-level patient data from the Get With The Guidelines-Stroke nationwide US registry. They recognized patients with BAO who received EVT within a day of symptom onset. The in-hospital mortality, discharge home, ambulatory at discharge, independent at discharge (modified Rankin Scale score 0 to 2), substantial reperfusion (modified Thrombolysis in Cerebral Infarction score 2b or 3), and symptomatic intracranial hemorrhage were the main outcomes that they investigated. They also examined the link between time from symptom onset to treatment with EVT and results by using logistic regression models.
In the time period, 3,015 patients with BAO received EVT as treatment. The average age was 65.9 years, 1,170 patients were women (38.8%), and the median National Institutes of Health Stroke Scale score at presentation was 17 (interquartile range, 8–26). Investigators noted an overall rise in the median onset to EVT times (380–411 minutes; P=0.016) between 2015 and 2019. However, there was no noteworthy variation in the proportion of patients treated within 6 hours of symptom onset (48.4%–44.0%; P=0.17). The study group also noticed considerably lower odds of in-hospital mortality (adjusted odds ratio [aOR], 0.55 [95% CI, 0.45–0.68]) and symptomatic intracranial hemorrhage (aOR, 0.52 [95% CI, 0.32–0.84]) after making adjustments for the patient and hospital-level factors. When the onset to EVT time was at most 6 hours compared with more than 6 hours, they also noted considerably higher odds of ambulation at discharge (aOR, 1.72 [95% CI, 1.37–2.16]), discharge home (aOR, 2.19 [95% CI, 1.73–2.77]), and independence at discharge (aOR, 2.21 [95% CI, 1.66–2.95]). Furthermore, they found that within 6 hours of symptom onset, the occurrence of the fastest decay in good outcomes per hour took place. Investigators concluded that there were links between improved outcomes and faster treatment from symptom onset for patients with BAO treated with EVT. Hence, the results substantiate the efforts to administer EVT to patients with BAO rapidly.
Link:www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056554
