Stroke: Vascular and Interventional Neurology (Nov 2021)

Abstract 1122‐000147: Factors associated with the Delayed Door to Puncture Time for the Basilar Artery Occlusion patient

  • Brandon Nguyen,
  • Ichiro Yuki,
  • Dana Stradling,
  • Jordan C Xu,
  • Kiarash Golshani,
  • Wengui Yu,
  • Shuichi Suzuki

DOI
https://doi.org/10.1161/SVIN.01.suppl_1.000147
Journal volume & issue
Vol. 1, no. S1

Abstract

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Introduction: Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence‐based. In the real‐world practice, it is also often encountered that the delayed initiation of the MT happens for this particular patient groups due to lack of cortical signs and other medical confounding factors. Methods: We retrospectively analyzed the angiographical and clinical outcomes of consecutive BAO patient who underwent MT in single institution. Onset to treatment (OTT), Door to Puncture (DTP) time were compared with those in anterior circulation large vessel occlusion (ACLVO) group who underwent MT in the same time period. For those showed significantly longer DTP time, the factors associated with the delayed initiation of the MT were analyzed. Results: A total of 271 patients underwent mechanical thrombectomy at UCI Medical Center between Jan 2016 and June 2021. Of these, 32 patients diagnosed as BAO by CTA and underwent MT were included in the study. Successful recanalization was achieved in 28 cases (87.5%), and symptomatic ICH occurred in 3 cases (9.4%). Nine patients (28.1%) showed good clinical outcomes (mRS 0–3) at 3 months. The median Onset to Puncture Time (OTT) was 340 min. The median DTP time (145 min) was significantly longer as compared to the ACLVO patients (99 min) (p value = 0.04). Of the 6 patients who showed significant delay in the initiation of intervention (DTP>300 min), 5 patients (83.3%) did not have the initial “stroke‐code activation” at the time of ED arrival. The cause of the delay was due to lack of cortical sign (3), bilateral spontaneous sustained clonus, which misinterpreted as seizure (1), AMS with non‐focal neurological signs interpreted as encephalopathy (2). Conclusions: DTP of the patients who underwent MT for BAO was significantly longer than that in ACLAO. Lack of cortical sings which are markers of ACLVO were associated with delayed activation of stroke code. Establishment of BAO screening in the ED assessment and prompt activation of Stroke code may contribute to the improvement of MT treatment for the BAO patients.

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