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The Combination of Atrial Fibrillation and Occlusion Site Predicts In Situ Atherosclerotic Thrombosis in Basilar

Yukishige Hashimoto1, Fusao Ikawa1, Reo Kawano2

  • 1Department of Neurosurgery, Shimane Prefectural Hospital, Izumo 693-0068, Japan.

Journal of Clinical Medicine
|September 27, 2025
PubMed

Insights

A simple classification combining proximal occlusion and atrial fibrillation status can help differentiate basilar artery occlusion (BAO) subtypes. This method accurately predicts in situ atherosclerotic thrombosis (ISAT) in BAO patients, aiding pre-procedural assessment.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Accurate stroke etiology evaluation in basilar artery occlusion (BAO) is challenging.
  • Distinguishing between in situ atherosclerotic thrombosis (ISAT) and cardioembolic (CE) subtypes of BAO is crucial for treatment.
  • A simple, practical method for predicting BAO subtypes is needed.

Purpose of the Study:

  • To develop and validate a simple classification for predicting the ISAT subtype of BAO.
  • To identify clinical and imaging predictors differentiating ISAT from CE subtypes.
  • To assess the diagnostic performance of the proposed classification.

Main Methods:

  • Retrospective analysis of 33 patients with BAO.
  • Classification of BAO location (proximal, middle, distal) and etiology (ISAT vs. CE).
  • Multivariable analysis to identify independent predictors of ISAT; stratification into four groups based on occlusion site and atrial fibrillation (AF).

Main Results:

  • ISAT accounted for 24% of BAO cases.
  • Proximal occlusion and absence of AF were independently associated with ISAT (OR 0.02-0.03).
  • A classification based on proximal occlusion and AF status achieved 75% sensitivity and 100% specificity for ISAT, with an AUC of 0.955.

Conclusions:

  • A classification combining proximal BAO and absence of AF effectively differentiates ISAT.
  • This simple method shows potential for pre-procedural subtype prediction in BAO.
  • Further validation in larger cohorts is warranted.

Keywords:
atrial fibrillationbasilar artery occlusioncardioembolicin situ atherosclerotic thrombosisocclusion siteproximal occlusion

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