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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. Tajiri H, Mori T , Iwata T, Uesugi T, Nakazaki M. SNR2010 Bologna. - PowerPoint PPT Presentation
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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.