Fast track — ArticlesTreatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study
Introduction
Stroke is the leading cause of disability in developed countries.1 Posterior circulation stroke accounts for about 20% of all ischaemic strokes. The basilar artery, which is the main vessel of the posterior circulation, supplies most of the brainstem and occipital lobes and part of the cerebellum and thalami. Owing to different degrees of involvement of the brainstem, patients with acute basilar artery occlusion (BAO) can present with symptoms that vary from isolated cranial nerve palsies or hemiplegia to the locked-in state or coma. Despite recent advances in the treatment of acute stroke, the rate of death or disability associated with BAO is almost 80%.2, 3, 4
Randomised trials have shown the safety and efficacy of intravenous thrombolysis (IVT) given within 4·5 h of the onset of the symptoms of acute ischaemic stroke and intra-arterial thrombolysis given within 6 h.5, 6, 7, 8, 9, 10 Unfortunately, the results of these randomised acute stroke trials do not directly apply to patients with an acute BAO because only few, if any, of these patients were included. BAO has not been studied in isolation in randomised clinical trials because of its low incidence: only about 5% of all patients who have thrombolysis for stroke have BAO.4, 11 We are aware of only one randomised trial of treatment in patients with an acute BAO, which was terminated prematurely because of poor recruitment.12 Case series of patients with BAO found the outcomes of patients treated with antithrombotic therapy (AT), IVT, or intra-arterial therapy (IAT) were similar.2, 13 The primary aim of the Basilar Artery International Cooperation Study (BASICS) was to obtain a better understanding of outcomes after acute BAO and to study potential differences in treatment response in anticipation of a definitive randomised controlled trial of acute treatment in these patients.
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Patients
BASICS was a prospective, observational, international registry of consecutive patients aged 18 years or older who presented with an acute symptomatic and radiologically confirmed BAO.14 Patients were eligible for entry if they presented with symptoms or signs attributable to disruption of the posterior circulation, and had a BAO as confirmed by CT angiography (CTA), magnetic resonance angiography (MRA), or conventional contrast angiography. BAO was defined as complete obstruction of flow in
Results
619 patients from 48 centres in Europe (41), South America (3), North America (2), Australia (1), and the middle east (1) were included in the registry. Participating centres and the number of patients recruited per centre are listed at the end of the paper. One centre was excluded from participation in the registry because not all pertinent data on consecutive patients were being recorded.
183 patients were treated with AT, 121 with IVT, and 288 with IAT. Of the patients treated with IVT, 80
Discussion
This is a prospective, international observational study of consecutive patients who presented with an acute symptomatic BAO. Although, to date, no data from a randomised controlled trial support the use of IAT for BAO, IAT was by far the most commonly used treatment type in our registry. Almost 50% of patients were treated with primary IAT: 56% of patients with a severe deficit and 38% of patients with a mild-to-moderate deficit. Additionally, 7% were treated with IVT followed by IAT.
Our
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BASICS study group members listed at end of report.