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Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center

Long-Term Clinical Outcome After Emergency MR-based Reperfusion Therapy for Acute Basilar Artery Occlusion. Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center Kamakura City, Japan. Tajiri H, Mori T , Iwata T, Uesugi T, Nakazaki M. SNR2010 Bologna.

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Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center

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  1. Long-Term Clinical Outcome After Emergency MR-based Reperfusion Therapy for Acute Basilar Artery Occlusion Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center Kamakura City, Japan Tajiri H, Mori T, Iwata T, Uesugi T, Nakazaki M. SNR2010 Bologna

  2. Background and Purpose • It remains uncertain whether or not emergency MR-based reperfusion therapy (RT) can improve hyperacute stroke patients suffering from basilar artery occlusion (BAO). • The purpose of our retrospective study was to investigate long-term clinical outcome after emergency MR-based reperfusion therapy for acute BAO.

  3. Patients • who were admitted from January 2004 to June 2009 • within 48 hours from stroke onset • who underwnet emergency MRA, which demonstrated no visualization of the basilar artery.

  4. Candidates for emergency reperfusion therapy（ERT) • MRA suggested the BA occlusion. • DWIs showed no extensive high signal intensity area in pons or cerebelli • CT scans or MRIs showed no hemorrhage. • NIHSS score was 5 or more on admission.

  5. Group • Group E: Patients whom gave written informed consent for ERT and underwent ERT (intravenous rt-PA or endovascular treatment). • Group C: Patients who did not give written informed consent for ERT .

  6. Evaluation • Patients’ basic characteristics on admission (age, gender, stroke subtypes) • NIHSS score on admission (NIHSS on adm) • Onset-to-admission time （OTA） • NIHSS score on the 7th day (NIHSS on 7th) • modified Rankin Scale at 3 months (3M-mRS) • Survival at 3 months (3M-Survival)

  7. Results • Overall acute ischemic stroke patients: 2079 patients • Acute BA occlusion patients (≦48hrs): 52 patients • Candidates for emergency RT:40 patients • Patients who underwent RT: 25 patients • (group E) • Patients who did not : 15 patients • (group C) (RT: reperfusion therapy)

  8. Reperfusion Treatment Patients in group E: 25 patients ・ Intra-arterial Fibrinolysis (IF: UK 60,000～420,000U): 9cases ・ Balloon Angioplasty： 3 cases ・ IF + Clot Removal Therapy (CRT): 3 cases ・ IF + BA + CRT: 4 cases ・ BA + stenting: 4 cases ・ rt-PAiv: 2 cases

  9. Recanalization following Reperfusion Treatment Patients in group E: 25 patients Successful recanalizaton:16 (64%) Unsuccess: 9

  10. Case 1 (7.25h from onset) Sudden onset quadriparesis, Disturbed level of consciousness. Af(+) MRA (AP view)MRA (Lateral view)

  11. Emergency intra-arterial fibrinolysis Partial BAO(basilar tip) Microcatheter Left VAG(APview) Intra-arterial fibrinolysis(IF)After IF(UK 240,000U)

  12. Case 2: Intracranial stenting A-76-year old woman, quadriparesis, NIHSS 22

  13. Intracranial stenting

  14. Case 3 DWI and MRA

  15. Emergency Crot Removal from the BA

  16. Patients’ baseline characteristics Group E (n=25) Group C (n=15) P 74 77 17 11 8 4 Age(median, yo) Gender Male Female n.s. n.s. n.s. OTA (hrs; median) 1.40 2.50 NIHSS on adm (median) • 14 (5-34) • 22(5-36) P<0.05 10 　　 6 15 9 Stroke subtypes Cardiogenic Atherosclerotic n.s.

  17. Clinical Outcome Group E (n=25) Group C (n=15) P NIHSS on the 7th day (median) 14 (2-42) • 37 (5-42) P<0.01 3-month mRS (median) 4 5 P<0.05 3-month Survival 21 (84%) 8 (53%) P<0.05

  18. Acute Stroke Patients MRI Sumarry of Patients

  19. Conclusion Among ischemic stroke patients who underwnet MR-based acute treatment, patients who underwent emergency reperfusion therapy for acute basilar artery occlusion had longer survival and favorable clinical outcome than in patients who did not.

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