Longer procedure times are associated with less favorable clinical outcomes for patients with acute basilar artery occlusion (ABAO), according to study findings published in Neurology. 

While previous studies have shown that procedure time is associated with outcomes in patients with large vessel occlusions, this association is unclear in patients with ABAO. Researchers conducted a study to assess the relationship between procedure time and clinical outcomes in patients with ABAO undergoing endovascular treatment (EVT).

The researchers collected data from the BASILAR registry, which is a nationwide, prospective, nonrandomized study on patients receiving EVT and standard medical therapy in China. This study included adults aged 18 and older with a confirmed ABAO diagnosis and who presented within 24 hours of the occlusion. 

The researchers defined procedure time as the time starting from groin puncture to successful recanalization or the last failed attempt. Results were reported in 3 groups based on PT: fast (PT ≤ 60 minutes), intermediate (60 min < PT ≤ 120 minutes), and extended (120 minutes < PT ≤ 300 minutes).

We cannot control the age, infarct volume and the stroke severity, and only can partly control the onset to treatment workflow, however, what we can improve are recanalization and the procedure.

The primary outcome was a favorable functional outcome, which was defined by a modified Rankin Scale (mRS) score of 0 to 3 at 90 days. The mRS scale ranges from 0 (no symptoms) to 6 (death). 

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Of the 829 patients in the BASILAR registry, there were 633 patients treated with EVT included in this study. The median age of participants was 64 years (interquartile ratio [IQR], 56-73) and 25% were women. The median procedure time was 103 minutes (IQR, 70-148). 

Patients who had intermediate and extended procedure times displayed higher rates of hypertension and lower rates of atrial fibrillation. There was a higher proportion of vessels distributed among patients in the fast group (56%), compared with patients in the intermediate and extended groups (35.9% vs 22.9%, respectively). 

There were higher rates of stent interventions for patients in intermediate and extended groups. The researchers found that procedure time was significantly associated with favorable outcomes (odds ratio [OR], 0.80; 95% CI, 0.72-0.88, per 30 min). Procedures lasting longer than 75 minutes were associated with increased mortality risk and unfavorable outcomes. 

In the study population, 286 (45.2%) patients were deceased, 204 (32.2%) patients had favorable outcomes, and 45 (7.1%) patients experienced symptomatic intracerebral hemorrhage.

The fast group was more likely to have favorable functional outcomes (47.7%) compared to the intermediate (33.8%) and extended (23.3%) groups (P <.001). Additionally, 90-day mortality was the lowest in the fast group (35.8%), compared to the intermediate (42.3%) and extended groups (54.2%; P <.01).

“We cannot control the age, infarct volume and the stroke severity, and only can partly control the onset to treatment workflow, however, what we can improve are recanalization and the procedure,” the researchers stated. 

Study limitations included selection bias, bias due to operator skill level, lack of generalizability, and lack of specific infarct data, such as growth and volume. 

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Guo C, Song J, Li L, et al. Association of procedure time with clinical and procedural outcome in patients with basilar occlusion undergoing embolectomy. Neurology. Published online May 18, 2023. doi:10.1212/WNL.0000000000207395