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01-12-2021 | Stroke | Original Article

Thrombectomy for Comatose Patients with Basilar Artery Occlusion

A Multicenter Study

Authors: Adrien Guenego, Ludovic Lucas, Benjamin Gory, Sébastien Richard, Mathilde Aubertin, David Weisenburger-Lile, Julien Labreuche, Cyril Dargazanli, Amel Benali, Romain Bourcier, Lili Detraz, Stéphane Vannier, Maud Guillen, François Eugene, Gregory Walker, Ronda Lun, Andrew Wormsbecker, Célina Ducroux, Michel Piotin, Raphael Blanc, Arturo Consoli, Bertrand Lapergue, Robert Fahed, ETIS investigators

Published in: Clinical Neuroradiology | Issue 4/2021

Abstract

Purpose

Acute ischemic stroke (AIS) secondary to a basilar artery occlusion (BAO) carries a poor prognosis, especially in cases of severe symptoms, such as coma at presentation. Despite a lack of evidence, mechanical thrombectomy (MT) is often performed as the procedural risks are felt to be minimal compared to the natural history. We sought to evaluate MT efficacy and safety in comatose BAO patients.

Methods

We performed a retrospective analysis of a multicenter prospective cohort of consecutive AIS patients with BAO who underwent MT. We compared baseline characteristics between comatose and noncomatose BAO patients, as well as clinical outcomes (modified Rankin scale, mRS 0–3 at 3 months). Using a multivariate logistic regression, we examined the population of comatose patients for baseline predictive factors of mortality.

Results

We included 269 patients, 72 (27%) comatose and 197 (73%) non-comatose. Despite similar recanalization rates between comatose and non-comatose patients (83% vs. 90% p = 0.221), comatose patient long-term outcomes were dramatically worse (11% mRS 0–3 vs. 54%, p < 0.0001) and mortality was higher (64% vs. 34%, p < 0.0001). Baseline predictors of mortality at 3 months among comatose BAO patients after multivariate analysis were the following: male sex (odds ratio, OR 31.20, 2.57–378.52, p = 0.007), older age (OR 1.13, 1.04–1.24, p = 0.007) and higher serum glucose levels (OR 1.54, 1.07–2.21, p = 0.019).

Conclusion

Thrombectomy is technically effective for BAO patients presenting with coma; however, the long-term favorable outcome remains poor. Male sex, old age and hyperglycemia were predictors of mortality in these patients.

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Title: Thrombectomy for Comatose Patients with Basilar Artery Occlusion
A Multicenter Study
Authors: Adrien Guenego
Ludovic Lucas
Benjamin Gory
Sébastien Richard
Mathilde Aubertin
David Weisenburger-Lile
Julien Labreuche
Cyril Dargazanli
Amel Benali
Romain Bourcier
Lili Detraz
Stéphane Vannier
Maud Guillen
François Eugene
Gregory Walker
Ronda Lun
Andrew Wormsbecker
Célina Ducroux
Michel Piotin
Raphael Blanc
Arturo Consoli
Bertrand Lapergue
Robert Fahed
ETIS investigators
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Coma
Thrombectomy
Published in: Clinical Neuroradiology / Issue 4/2021
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-021-01001-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thrombectomy for Comatose Patients with Basilar Artery Occlusion

A Multicenter Study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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