Treatment Outcomes by Initial Neurological Deficits in Acute Stroke Patients with Basilar Artery Occlusion: The RESCUE Japan Registry 2

• Published in: Journal of stroke and cerebrovascular diseases Vol. 29; no. 11; p. 105256
• Main Authors: Yoshimoto, Takeshi, Tanaka, Kanta, Yamagami, Hiroshi, Uchida, Kazutaka, Inoue, Manabu, Koge, Junpei, Ihara, Masafumi, Toyoda, Kazunori, Imamura, Hirotoshi, Ohara, Nobuyuki, Morimoto, Takeshi, Sakai, Nobuyuki, Yoshimura, Shinichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: Aged; Aged, 80 and over; Basilar artery occlusion; Dependent Ambulation; Disability Evaluation; Endovascular Procedures - adverse effects; Endovascular therapy; Female; Humans; Japan; Male; Middle Aged; Mobility Limitation; Outcomes; Prospective Studies; Recovery of Function; Severity of Illness Index; Stroke; Stroke - diagnosis; Stroke - etiology; Stroke - physiopathology; Stroke - therapy; Time Factors; Treatment Outcome; Vertebrobasilar Insufficiency - complications; Vertebrobasilar Insufficiency - diagnosis; Vertebrobasilar Insufficiency - physiopathology; Vertebrobasilar Insufficiency - therapy; Japan; Stroke; Endovascular therapy; Basilar artery occlusion; Outcomes
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2020.105256

We hypothesized that the relationships between treatments and outcomes in acute basilar artery occlusion (BAO) are different, depending on the severity of initial neurological deficits. Of 2420 ischemic stroke patients with large vessel occlusion in a prospective, multicenter registry in Japan, patients with acute BAO were enrolled. Subjects were divided into two severity groups according to the baseline NIH Stroke Scale score: severe (≥10) and mild (<10) groups. The primary effectiveness outcome was favorable outcome, defined as modified Rankin Scale score 0–3 at 3 months. Safety outcomes included any intracranial hemorrhage (ICH) within 72 h. Outcomes in each group were compared between patients who received endovascular therapy (EVT) and those with standard medical treatment (SMT). In this study, 167 patients (52 female; median age 75 years) were analyzed. The favorable outcome was seen in 93 patients (56%) overall. In the severe group (n = 128), the proportion of favorable outcome was higher in patients who received EVT (60/111, 54%) than those with SMT (2/17, 12%, P < 0.01). In the mild group (n = 39), the rates of favorable outcome were comparable between the EVT (13/18, 72%) and SMT patients (18/21, 86%, P = 0.43). No significant differences in the rates of any ICH were seen among any groups. In acute BAO stroke with severe neurological deficit, independent ambulation was more frequently seen in patients who received EVT than those with SMT. Patients with mild neurological deficits showed similar rates of independent ambulation between the two treatment selections.