Long-Term Clinical Outcome After Emergency MR-based Reperfusion Therapy for Acute Basilar Artery

Occlusion

Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center

Kamakura City, Japan SNR2010 Bologna

Tajiri H, Mori T, Iwata T, Uesugi T, Nakazaki M.

Background and Purpose

• It remains uncertain whether or not emergency MR-based reperfusion therapy (RT) can improve hyperacute stroke patients suffering from basilar artery occlusion (BAO).

• The purpose of our retrospective study was to investigate long-term clinical outcome after emergency MR-based reperfusion therapy for acute BAO.

Patients

• who were admitted from January 2004 to June 2009• within 48 hours from stroke onset• who underwnet emergency MRA, which

demonstrated no visualization of the basilar artery.

Candidates for emergency reperfusion therapy （ ERT)

• MRA suggested the BA occlusion.• DWIs showed no extensive high signal

intensity area in pons or cerebelli • CT scans or MRIs showed no hemorrhage.• NIHSS score was 5 or more on admission.

Group• Group E:

Patients whom gave written informed consent for ERT and underwent ERT (intravenous rt-PA or endovascular treatment).

• Group C: Patients who did not give written informed consent for ERT .

Evaluation

• Patients’ basic characteristics on admission (age, gender, stroke subtypes)

• NIHSS score on admission (NIHSS on adm)• Onset-to-admission time （ OTA ）• NIHSS score on the 7th day (NIHSS on 7th)• modified Rankin Scale at 3 months (3M-mRS)• Survival at 3 months (3M-Survival)

• Overall acute ischemic stroke patients: 2079 patients• Acute BA occlusion patients ( 48hrs): ≦ 52 patients• Candidates for emergency RT: 40 patients • Patients who underwent RT: 25 patients

(group E) • Patients who did not : 15 patients

(group C) 　

Results

(RT: reperfusion therapy)

Patients in group E: 25 patients 　　・ Intra-arterial Fibrinolysis (IF: UK 60,000 ～ 420,000U): 9 cases ・ Balloon Angioplasty ： 3 cases・ IF + Clot Removal Therapy (CRT): 3 cases・ IF + BA + CRT: 4 cases・ BA + stenting: 4 cases・ rt-PA iv: 2 cases

Reperfusion Treatment

Patients in group E: 25 patients 　　 Successful recanalizaton: 16 (64%) 　　 Unsuccess: 9

Recanalization following Reperfusion Treatment

Sudden onset quadriparesis , Disturbed level of consciousness. Af(+)

MRA (AP view) 　　　　　　　　　　　　　　　　 MRA (Lateral view) 　　　　　　　

Case 1 (7.25h from onset)

Emergency intra-arterial fibrinolysis

Left VAG(AP view) 　　　　　 Intra-arterial fibrinolysis(IF) 　　　　 After IF(UK 240,000U)

Partial BAO(basilar tip)

　

Microcatheter

Case 2: Intracranial stentingA-76-year old woman, quadriparesis, NIHSS 22

Intracranial stenting

Case 3DWI and MRA

Emergency Crot Removal from the BA

Patients’ baseline characteristicsGroup E(n=25)

Age(median, yo)

Gender Male Female

7477 　　

17 11 8 4

P

n.s.

n.s.

n.s.

Group C(n=15)

OTA (hrs; median) 1.40 2.50 n.s.

Stroke subtypes 　　　　　　　　　 Cardiogenic　　　　　 Atherosclerotic

10 　　 615 　　 　 9

NIHSS on adm (median)

22 (5-36) 14 (5-34) P<0.05

Clinical OutcomeGroup E(n=25) P

Group C(n=15)

NIHSS on the 7th day (median)

3-month mRS (median)

14 (2-42) 37 (5-42)

4 5

3-month Survival 21 (84%) 8 (53%) P<0.05

P<0.01

P<0.05

Sumarry of PatientsCandidates for

emergency reperfusion therapy40 patients

Group E 25 patients

Successful recanalizati

on

16 patient

s3M-mRS

Median: 2

Unsuccess

9 patient

s3M-mRS

Median: 5

Group C 15 patients

３ M-mRSMedian: 5

Not candidates15 patients

Acute Stroke PatientsMRI

Conclusion

Among ischemic stroke patients who underwnet MR-based acute treatment, patients who underwent emergency reperfusion therapy for acute basilar artery occlusion had longer survival and favorable clinical outcome than in patients who did not.