Adrien Guenego1,2, Ludovic Lucas3, Benjamin Gory4,5,6, Sébastien Richard6,7, Mathilde Aubertin1, David Weisenburger-Lile8, Julien Labreuche9, Cyril Dargazanli10, Amel Benali10, Romain Bourcier11, Lili Detraz11, Stéphane Vannier12, Maud Guillen12, François Eugene13, Gregory Walker14,15, Ronda Lun14, Andrew Wormsbecker16, Célina Ducroux1, Michel Piotin1, Raphael Blanc1, Arturo Consoli17, Bertrand Lapergue8, Robert Fahed18,19. 1. Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France. 2. Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium. 3. Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. 4. Department of Diagnostic, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France. 5. Therapeutic Neuroradiology, Université de Lorraine, IADI, INSERM U1254, 54000, Nancy, France. 6. INSERM U1116, CHRU-Nancy, 54000, Nancy, France. 7. Department of Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France. 8. Neurovascular Unit, Foch Hospital, Suresnes, France. 9. ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, Univ. Lille, CHU Lille, 59000, Lille, France. 10. Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France. 11. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France. 12. Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France. 13. Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France. 14. Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa-Civic Campus, 1053 Carling Avenue, K1Y4E9, Ottawa, ON, Canada. 15. Department of Medicine-Division of Neurology; Royal Columbian Hospital, New Westminster, University of British Columbia, British Columbia, Canada. 16. Department of Critical Care and Internal Medicine; Royal Columbian Hospital, New Westminster, University of British Columbia, British Columbia, Canada. 17. Department of Neuroradiology, Foch Hospital, Suresnes, France. 18. Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France. robert.fahed@hotmail.fr. 19. Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa-Civic Campus, 1053 Carling Avenue, K1Y4E9, Ottawa, ON, Canada. robert.fahed@hotmail.fr.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
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Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: Wouter J Schonewille; Christine A C Wijman; Patrik Michel; Christina M Rueckert; Christian Weimar; Heinrich P Mattle; Stefan T Engelter; David Tanne; Keith W Muir; Carlos A Molina; Vincent Thijs; Heinrich Audebert; Thomas Pfefferkorn; Kristina Szabo; Perttu J Lindsberg; Gabriel de Freitas; L Jaap Kappelle; Ale Algra Journal: Lancet Neurol Date: 2009-07-03 Impact factor: 44.182