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Time is brain(stem) in basilar artery occlusion.

Mervyn D I Vergouwen1, Ale Algra, Thomas Pfefferkorn

  • 1UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. M.D.I.Vergouwen@umcutrecht.nl

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PubMed
Summary

Early recanalization therapy for basilar artery occlusion (BAO) improves outcomes. Delaying treatment beyond six hours significantly increases the risk of poor functional outcomes in BAO patients.

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Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neurology

Background:

  • Basilar artery occlusion (BAO) is a severe neurological emergency.
  • Current clinical practice often extends the time window for recanalization therapy in BAO without strong evidence.
  • The Basilar Artery International Cooperation Study (BASICS) registry provides data on BAO patient outcomes.

Purpose of the Study:

  • To investigate the relationship between the time to recanalization therapy and functional outcomes in patients with BAO.
  • To evaluate the scientific evidence supporting extended time windows for BAO treatment.

Main Methods:

  • Analysis of data from the prospective, multicenter BASICS registry (n=619) of patients with confirmed BAO.
  • Categorization of patients into four groups based on time to recanalization therapy: ≤3, >3-6, >6-9, and >9 hours.
  • Use of Poisson regression to calculate adjusted risk ratios for poor functional outcome (modified Rankin Scale 4-6) at 1 month, with the ≤3 hours group as reference.

Main Results:

  • A longer time to recanalization therapy was associated with an increased risk of poor functional outcome.
  • Patients treated >6 hours after BAO onset had significantly higher adjusted risk ratios for poor outcomes (1.26 for >6-9 hours, 1.47 for >9 hours).
  • The risk of poor functional outcome increased progressively with treatment delays beyond 6 hours.

Conclusions:

  • Early recanalization therapy in basilar artery occlusion is crucial for achieving favorable functional outcomes.
  • Treatment delays exceeding 6 hours significantly elevate the likelihood of poor outcomes in BAO patients.
  • The findings challenge the current practice of using extended time windows for BAO recanalization therapy without sufficient evidence.