Acute Basilar Artery Occlusion Thrombectomy Performed in Early (<6 hours) and Late Time Window (>6 hours) from the PC-SEARCH Registry
Nameer Aladamat1, Adam Mierzwa2, Syed Zaidi3, Khaled Gharaibeh4, Ehad Afreen5, Sami Al Kasab6, Ashley Nelson6, Mudassir Farooqui7, Juan Vivanco Suarez7, Ashutosh Jadhav8, Shashvat Desai9, Gabor Toth10, Anas Alrohimi11, Thanh Nguyen12, Klein Piers13, Mohamad Abdalkader12, Aditya Pandey14, Sravanthi Koduri14, Nirav Vora15, Shivangi Vora15, Mouhammad Jumaa3, Santiago Ortega Gutierrez7
1The University of Toledo, 2Promedica, 3ProMedica Stroke Network, 4ProMedica Neurosciences Center, 5Promedica Physicians Group Neurology, 6Medical University of South Carolina, 7University of Iowa, 8University of Pittsburgh, 9University of Pittsburgh Medical Center, 10Cleveland Clinic Foundation, 11University of Alberta, 12Boston Medical College, 13Boston University, 14University of Michigan, 15Ohio Health
Objective:
Evaluate the effect of early and late time window in a cohort of patients with BAO treated with thrombectomy.
Background:
Acute Basilar Artery Occlusion (BAO) results in high rate of morbidity and mortality. Recent randomized controlled trials from China demonstrated clinical benefit of mechanical thrombectomy.
Design/Methods:
PC-SEARCH is a large multi-centered retrospective registry of consecutive acute BAOs treated with thrombectomy with contributions from eight high-volume centers across the United States from July 2015 – December 2021. Patients were included in this registry if they received mechanical thrombectomy or intra-arterial thrombolysis within 24 hours of last seen normal. Registry includes data from baseline characteristics, pre- and intra- procedural data, radiographic and clinical outcomes. Good clinical outcomes were defined as mRS ≤ 3. Times were dichotomized into early (< 6 hours) and late (> 6 hours) time windows. Multivariate logical regression models were used to evaluate predictors of good outcome.
Results:
PC-SEARCH registry captured 519 patients, 479 with recorded outcomes at 90 days, Mean last-seen-normal to groin-puncture time was 132 min in the early time window and 765 min in the late time window patients; while NIHSS ( 17 vs 16, p 0.057), age (mean 65.8 vs 67.4, p 0.175), PC-ASPECTS (median 10 vs 9, p value 0.45), and door-groin puncture time (295 min vs 389 p 0.28) were not different between the two groups. Good recanalization (≥TICI 2b) was achieved in 82% of patients in the early time window and 81.5 % in the late time window (p 0.45). Rate of good outcome (45.8 vs 41.8, p value 0.41), sICH (7.1 vs 6.8 p 0.897) and mortality (40.3 vs 43.4 p 0.869) were similar between cohorts.
Conclusions:
In patients with acute basilar artery occlusion with excellent PC ASPECT score, similar rates of good clinical outcome can be achieved in the early and late time window.