title: Time is brain(stem) in basilar artery occlusion.
abstract: OBJECTIVE
  The frequent use of a longer time window for recanalization therapy in patients with basilar artery occlusion (BAO) in daily practice is not supported by any scientific evidence. We investigated the relationship between time to recanalization therapy and functional outcome in BAO with data from the Basilar Artery International Cooperation Study (BASICS).
  
  
  METHODS
  BASICS is a prospective multicenter registry of patients (n=619) with radiologically confirmed BAO. We analyzed patients receiving intravenous thrombolysis or intra-arterial treatment. Patients were divided into 4 groups based on the interval between estimated time of BAO and start of recanalization therapy: ≤3 hours (n=134), >3 to ≤6 hours (n=151), >6 to ≤9 hours (n=56), and >9 hours (n=68). Primary outcome measure was poor functional outcome (modified Rankin scale score 4-6) after 1 month. We calculated adjusted risk ratios with 95% CIs using Poisson regression analyses with the ≤3 hours group as the reference group.
  
  
  RESULTS
  Patients had an increased risk of poor functional outcome as time to recanalization therapy became longer (≤3 hours: 62%; >3 to ≤6 hours: 67% [adjusted risk ratio, 1.06; 0.91-1.25]; >6 to ≤9 hours: 77% [adjusted risk ratio, 1.26; 1.06-1.51]; >9 hours: 85% [adjusted risk ratio, 1.47; 1.26-1.72]).
  
  
  CONCLUSIONS
  Early recanalization therapy in patients with BAO is associated with a more favorable outcome with a significant increased chance of a poor outcome when recanalization therapy is started >6 hours after estimated time of BAO.
authors.affiliation: UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. M.D.I.Vergouwen@umcutrecht.nl
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.forename: Christina M
authors.initials: CM
authors.lastname: Rueckert
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
mesh_terms: D000368:Aged; D001933:Brain Stem / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods; D008875:Middle Aged; D020127:Recovery of Function; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000473:pathology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents