title: Multimodal recanalization therapy in acute basilar artery occlusion: long-term functional outcome and quality of life.
abstract: OBJECTIVE
  Multimodal recanalization therapy in patients with acute basilar artery occlusion provides high recanalization rates. A substantial subset of treated patients survives with only minor or moderate functional handicap. However, long-term functional outcome and quality of life in these patients have rarely been systematically analyzed.
  
  
  METHODS
  In this monocentric retrospective study, we analyzed mortality, long-term functional outcome (modified Rankin Scale), and quality of life (36-Item Short-Form Health Survey questionnaire) in all consecutive patients who had been treated for acute basilar artery occlusion in our institution between December 2002 and December 2009.
  
  
  RESULTS
  Ninety-one patients (57 male; median age, 65 years; range, 20-89 years) were treated by multimodal recanalization therapy. This included intravenous thrombolysis (n=32) with consecutive on-demand intra-arterial therapy (n=23) or intra-arterial therapy alone (n=59). The overall recanalization rate was 89%. After a median observation time of 4.2 years (range, 0.5-7.4 years), the mortality rate was 59%. Among the 35 survivors, 26 patients (74%) had a good or moderate long-term functional outcome (modified Rankin Scale ≤3). Health-related quality of life was better than that of unselected patients with stroke. Backward stepwise logistic regression identified intravenous thrombolysis (P=0.002) and female sex (P=0.001) as predictors of favorable functional long-term outcome (modified Rankin Scale ≤3). Coma at admission (Glasgow Coma Scale ≤8) was associated with poor outcome (modified Rankin Scale ≥4; P=0.036).
  
  
  CONCLUSIONS
  Long-term survival is achieved in approximately 40% of patients with basilar artery occlusion treated with multimodal recanalization therapy. Approximately 75% of the survivors have a favorable functional long-term outcome with an acceptable quality of life.
authors.affiliation: Department of Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany. Caroline.Ottomeyer@med.uni-muenchen.de
authors.forename: Caroline
authors.initials: C
authors.lastname: Ottomeyer
authors.forename: Judith
authors.initials: J
authors.lastname: Zeller
authors.forename: Gunther
authors.initials: G
authors.lastname: Fesl
authors.forename: Markus
authors.initials: M
authors.lastname: Holtmannspötter
authors.forename: Christian
authors.initials: C
authors.lastname: Opherk
authors.forename: Andreas
authors.initials: A
authors.lastname: Bender
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
authors.forename: Hartmut
authors.initials: H
authors.lastname: Brückmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology; D011379:Prognosis; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000523:psychology / Q000601:surgery*; D055815:Young Adult