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

Aged Basilar Artery Brain Ischemia Coma Endovascular Procedures Humans Male Prospective Studies Retrospective Studies Stroke / diagnostic imaging Thrombectomy Treatment Outcome Vertebrobasilar Insufficiency / diagnostic imaging

Coma Endovascular revascularization Posterior circulation Stroke Thrombectomy

Journal

Clinical neuroradiology

ISSN: 1869-1447

Titre abrégé: Clin Neuroradiol

Pays: Germany

ID NLM: 101526693

Informations de publication

Date de publication:
Dec 2021

Historique:

received: 03 12 2020

accepted: 04 02 2021

pubmed: 12 3 2021

medline: 15 12 2021

entrez: 11 3 2021

Statut: ppublish

Résumé

Acute ischemic stroke (AIS) secondary to a basilar artery occlusion (BAO) carries a poor prognosis, especially in cases of severe symptoms, such as coma at presentation. Despite a lack of evidence, mechanical thrombectomy (MT) is often performed as the procedural risks are felt to be minimal compared to the natural history. We sought to evaluate MT efficacy and safety in comatose BAO patients. We performed a retrospective analysis of a multicenter prospective cohort of consecutive AIS patients with BAO who underwent MT. We compared baseline characteristics between comatose and noncomatose BAO patients, as well as clinical outcomes (modified Rankin scale, mRS 0-3 at 3 months). Using a multivariate logistic regression, we examined the population of comatose patients for baseline predictive factors of mortality. We included 269 patients, 72 (27%) comatose and 197 (73%) non-comatose. Despite similar recanalization rates between comatose and non-comatose patients (83% vs. 90% p = 0.221), comatose patient long-term outcomes were dramatically worse (11% mRS 0-3 vs. 54%, p < 0.0001) and mortality was higher (64% vs. 34%, p < 0.0001). Baseline predictors of mortality at 3 months among comatose BAO patients after multivariate analysis were the following: male sex (odds ratio, OR 31.20, 2.57-378.52, p = 0.007), older age (OR 1.13, 1.04-1.24, p = 0.007) and higher serum glucose levels (OR 1.54, 1.07-2.21, p = 0.019). Thrombectomy is technically effective for BAO patients presenting with coma; however, the long-term favorable outcome remains poor. Male sex, old age and hyperglycemia were predictors of mortality in these patients.

Identifiants

DOI: 10.1007/s00062-021-01001-9 PMID: 33704508

pubmed: 33704508

doi: 10.1007/s00062-021-01001-9

pii: 10.1007/s00062-021-01001-9

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

1131-1140

Informations de copyright

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