1069. Distinct Clinical Characteristics of Basilar Artery Occlusion Patients Treated with Thrombectomy
Authors: Michael Gregory Brandel, BA; Jeffrey Steinberg, MD; Rennert Rennert, MD; David Santiago-Dieppa, MD; Arvin Wali, MD; Keiko Kang, BS; Scott Olson, MD; J Pannell, MD; Alexander Khalessi, MD, MS (San Diego, CA)
Basilar artery (BA) occlusion patients may be at increased risk for delayed presentation and intubation due to ambiguous presenting symptoms in the setting of global neurological deterioration, decreased consciousness, and airway compromise that often occur with posterior circulation strokes.
We retrospectively compared the presenting symptoms and treatment for patients that underwent mechanical thrombectomy of the BA or middle cerebral artery (MCA) for acute ischemic stroke at our institution between April/2014 and July/2017. Categorical and continuous variables were assessed using chi-squared tests and t-tests, respectively. Multivariate logistic and linear regression were used to assess risk factors for intubation and prolonged last-known-normal-to-arrival time and door-to-puncture time. Time variables were log-transformed for analysis.
Overall, 124 patients were included (112 MCA, 12 BA). BA patients were less likely to present with weakness (75.0 vs. 97.3%, p=0.001), sensory deficit (25.0 vs. 57.1%, p=0.034), and aphasia, although this was not statistically significant (41.7 vs. 64.3%, p=0.125). Last-known-normal-to-arrival time (421 vs. 219 minutes, p=0.054) and door-to-puncture time (377 vs. 131 minutes, p<0.001) were longer for BA patients than MCA patients, and the rate of tPA was lower for BA patients than MCA patients (16.7 vs. 55.4%, p=0.011). There was a trend towards increased intubation for BA (58.3 vs. 33.9%, p=0.095). On multivariate analysis, BA patients were associated with longer door-to-puncture time (Beta=0.32, p=0.001), adjusting for NIHSS score and intubation status. However, BA occlusion was not associated with intubation when adjusting for NIHSS score and both time intervals. Door-to-puncture time remained significantly associated with intubation (odds ratio=2.8, p=0.006).
Differential clinical presentation of BA occlusion may challenge mature stroke systems in timely diagnosis and treatment metrics. Early recognition may prevent the need for intubation, lead to greater tPA use, and decrease time to thrombectomy. Mechanisms to increase awareness of this pathology should be further researched.