BACKGROUND Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1-4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86-95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. OBJECTIVE In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. METHOD BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). RESULTS The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0-3) in 40.7% of cases, 25.9% reached mRS 0-2, and 29.6% had a poor clinical outcome (mRS 4-5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. CONCLUSIONS In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.

中文翻译：

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基底动脉闭塞患者的急性中风治疗：单中心观察性研究。

背景技术由于基底动脉闭塞（BAO）引起的急性缺血性中风（AIS）占所有缺血性中风的1-4％。BAO导致中风，伴有功能不良的高风险，在未经治疗的病例中，有86-95％的人由于涉及重要的大脑结构而导致死亡。由于出现症状的可变性，诊断可能会延迟，并且由于致命预后的高风险，通常甚至在症状发作后的6小时内尝试进行急性治疗。目的在这项观察性研究中，我们回顾性分析了由BAO转诊至墨西拿大学医院卒中中心的AIS患者。我们旨在评估预后因素，并评估临床结果与后循环艾伯塔省卒中计划早期CT评分（pc-ASPECTS）和侧支状态之间的关联。方法BAO通过脑CT或脑血管造影证实。所有患者均接受了CT扫描和磁共振成像（MRI）。我们评估了每位患者的弥散加权成像（DWI）MR图像和后循环侧支评分（PC-CS）上的pc-ASPECTS。使用改良的兰金量表（mRS）在3个月时评估功能结局。结果研究人群包括27例患者；男16名，女11名。平均年龄为66（±14）岁。我们观察到40.7％的病例的预后良好（mRS 0-3），达到mRS 0-2的病例为25.9％，临床预后较差的病例（mRS 4-5）为29.6％。患者生存率为70.4％，而8例患者死亡（29.6％）。在7例患者中，pc-ASPECTS≥7。根据PC-CS的数据，在接受治疗之前，有33.3％的患者具有中等程度的侧支，而63.0％的患者具有良好的侧支状态。良好的预后与年龄，入院时的NIHSS评分，pc-ASPECTS，高胆固醇血症和女性性别显着相关，但与其他危险因素无关。结论在我们的研究中，我们发现年龄较小，入院时NIHSS得分低，pc-ASPECTS高但未开始治疗时间与良好的临床结局有关。转移患者的预后没有明显恶化。这些发现证实，尽管延误了诊断并延长了治疗时间，急性卒中治疗仍改善了BAO患者的临床结局，