No time to lose in basilar artery occlusion treatment

By Eleanor McDermid, Senior medwireNews Reporter

Patients with basilar artery occlusion (BAO) should undergo recanalization therapy as soon as possible, show data from BASICS.

The proportion of patients who were dead or functionally dependent at 1 month after the time of BAO rose in line with increasing treatment delay, say Mervyn Vergouwen (University Medical Center Utrecht, the Netherlands) and colleagues.

"Beyond 9 hours, the prognosis of patients with severe BAO is universally dismal despite recanalization therapy," they write in Stroke.

It was thought that patients with BAO might have a longer time window for recanalization relative to those with anterior circulation stroke, because of the potential for greater resistance to ischemia due to abundant white matter and better collateral circulation.

But the findings from 409 patients in the BASICS (Basilar Artery International Cooperation Study) registry show otherwise. Rates of death or dependency (modified Rankin Scale 4-6) were 62% if patients were treated 3 hours or less from the estimated time of onset, but 67%, 77%, and 85% if they were treated 3-6, 6-9, and more than 9 hours after onset, respectively.

Time of onset was defined as the first appearance of acute symptoms that led to the BAO diagnosis. Vergouwen et al explain that more than 60% of BAO patients may have prodromal symptoms, which would exclude them from clinical trials requiring treatment within a short time window.

"Therefore, we used an estimated time to treatment from the onset of symptoms consistent with a clinical diagnosis of BAO rather than the more commonly used time of onset of any symptom to treatment," they say. "Our findings support the use of a more liberal definition of time of onset in patients with BAO."

After accounting for age, National Institutes of Health Stroke Scale score, diabetes, prodromes, and occlusion location, patients treated more than 6 hours after symptom onset had a significantly increased risk for death or dependency relative to those treated up to 3 hours after onset.

"Our results imply that patients with BAO should be treated as soon as possible after symptom onset, similar to patients with ischemic stroke in the anterior circulation," conclude the researchers.

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