Thrombectomy for Comatose Patients with Basilar Artery Occlusion : A Multicenter Study

Area of Science:

• Neurology
• Interventional Neurology
• Vascular Neurology

Background:

• Basilar artery occlusion (BAO) is a severe form of acute ischemic stroke (AIS) with a typically poor prognosis.
• Comatose presentation in BAO patients indicates a particularly grave outlook.
• Mechanical thrombectomy (MT) is frequently employed for BAO despite limited evidence, based on perceived low procedural risk.

Purpose of the Study:

• To evaluate the efficacy and safety of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) who present with coma.
• To compare outcomes between comatose and non-comatose BAO patients treated with MT.
• To identify baseline predictors of mortality in comatose BAO patients undergoing MT.

Main Methods:

• Retrospective analysis of a multicenter prospective cohort of AIS patients with BAO undergoing MT.
• Comparison of baseline characteristics and clinical outcomes (modified Rankin Scale at 3 months) between comatose and non-comatose groups.
• Multivariate logistic regression analysis to determine mortality predictors in comatose patients.

Main Results:

• The study included 269 patients: 72 (27%) comatose and 197 (73%) non-comatose.
• Recanalization rates were similar between groups (83% vs. 90%, p=0.221).
• Comatose patients had significantly worse outcomes (11% mRS 0-3 vs. 54%, p<0.0001) and higher mortality (64% vs. 34%, p<0.0001).
• Predictors of mortality in comatose patients included male sex (OR 31.20), older age (OR 1.13), and higher serum glucose (OR 1.54).

Conclusions:

• Mechanical thrombectomy is technically feasible for BAO with coma but yields poor long-term functional outcomes.
• Mortality in comatose BAO patients treated with MT is predicted by male sex, advanced age, and hyperglycemia.
• Further research is needed to improve outcomes for this high-risk stroke population.