Ischemic stroke due to acute basilar artery occlusion: proportion and outcomes.
BACKGROUND
Multiple case series, mostly highly selected, have demonstrated a very high mortality following acute basilar artery occlusion. The more widespread availability and use of non-invasive vascular imaging over recent years has increased the rate of ABAO diagnosis.


OBJECTIVE
To estimate the proportion of diagnosed ABAO among all-cause ischemic stroke in an era of increasing use of non-invasive vascular imaging and to compare the characteristics and outcomes between these two groups.


METHODS
We compared 27 consecutive cases of ABAO identified in a university hospital between 2003 and 2007 with 311 unselected cases of ischemic stroke from two 4 month surveys.


RESULTS
ABAO diagnosis increased from 0.3% of all-cause ischemic stroke (2003-2004) to 1.1% (2007), reflecting the increased use of non-invasive vascular imaging. In comparison to all-cause ischemic stroke, ABAO patients were younger (mean age 60 vs. 71 years), were more likely to be male (89% vs. 60%), had less atrial fibrillation (7% vs. 26%), more severe strokes (baseline NIHSS over 20: 52% vs. 12%), higher admission white cell count (12,000 vs. 9000 cells/ mm3), lower admission systolic blood pressure (140 +/- 24 vs. 153 +/- 27 mmHg), higher in-hospital mortality rates (30% vs. 8%) and worse functional outcome (modified Rankin scale < or = 3, 22% vs. 56%) (P< 0.05 for all). Rates of reperfusion therapy for ABAO increased from 0 in 2003-2004 to 60% in 2007.


CONCLUSIONS
In this study, ABAO patients represented approximately 1% of all-cause ischemic stroke and were about a decade younger than patients with all-cause ischemic stroke. We report a lower ABAO mortality compared to previous more selected case series; however, most survivors had a poor functional outcome. Given the marked clinical heterogeneity of ABAO, a low threshold for non-invasive vascular imaging with a view to definitive reperfusion treatment is needed.
Stroke Center, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.
Simon D
SD
Israeli-korn
Yvonne
Y
Schwammenthal
Tali
T
Yonash-Kimchi
Mati
M
Bakon
Rakefet
R
Tsabari
David
D
Orion
Bella
B
Bruk
Noa
N
Molshatzki
Oleg
O
Merzeliak
Joab
J
Chapman
David
D
Tanne
D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D001281:Atrial Fibrillation / Q000453:epidemiology; D001488:Basilar Artery / Q000000981:diagnostic imaging*; D001794:Blood Pressure; D015984:Causality; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome