Thrombectomy for Comatose Patients with Basilar Artery Occlusion : A Multicenter Study.
Clin Neuroradiol
; 31(4): 1131-1140, 2021 Dec.
Article
em En
| MEDLINE
| ID: mdl-33704508
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 0-3â¯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% pâ¯= 0.221), comatose patient long-term outcomes were dramatically worse (11% mRS 0-3 vs. 54%, pâ¯<â¯0.0001) and mortality was higher (64% vs. 34%, pâ¯<â¯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, pâ¯= 0.007), older age (OR 1.13, 1.04-1.24, pâ¯= 0.007) and higher serum glucose levels (OR 1.54, 1.07-2.21, pâ¯= 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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Insuficiência Vertebrobasilar
/
Isquemia Encefálica
/
Acidente Vascular Cerebral
/
Procedimentos Endovasculares
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Humans
/
Male
Idioma:
En
Revista:
Clin Neuroradiol
Assunto da revista:
NEUROLOGIA
/
RADIOLOGIA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
França