Long-Term Clinical Outcome After Emergency MR-based Reperfusion Therapy for Acute Basilar Artery Occlusion Department of Stroke Treatment, Shonan Kamakura.

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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 SNR2010 Bologna Tajiri H, Mori T, Iwata T, Uesugi T, Nakazaki M.

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.

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.

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.

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.

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)

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) Results (RT: reperfusion therapy)

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

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

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

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

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

Intracranial stenting

Case 3 DWI and MRA

Emergency Crot Removal from the BA

Patients’ baseline characteristics Group E (n=25) Age(median, yo) Gender Male Female P n.s. Group C (n=15) OTA (hrs; median) n.s. Stroke subtypes Cardiogenic Atherosclerotic NIHSS on adm (median) 22 (5-36) 14 (5-34) P<0.05

Clinical Outcome Group E (n=25) P Group C (n=15) NIHSS on the 7th day (median) 3-month mRS (median) 14 (2-42)37 (5-42) 45 3-month Survival 21 (84%)8 (53%) P<0.05 P<0.01 P<0.05

Sumarry of Patients Acute Stroke Patients MRI

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.