Abstract
Background and Objectives: Previous studies have demonstrated the association between the procedure time (PT) and outcomes for patients with proximal large vessel occlusion (LVO), however, whether the relationship remains for patients with acute basilar artery occlusion (ABAO) was not clear. We aimed to characterize the association between PT and other procedure-related variables on clinical outcomes among patients with ABAO that underwent endovascular treatment (EVT).
Methods: Patients with ABAO that underwent EVT with a documented PT in the BASILAR study from January 2014 to May 2019 among 47 comprehensive centers in China were included. Multivariable analysis was performed to reveal the association between PT and 90-day modified Rankin Scale score, mortality, complications, and all-cause death at one year.
Results: Of the 829 patients from the BASILAR registry, 633 eligible patients were included. Longer procedure time were associated with a lower rate of favorable outcome (by 30min, adjusted OR 0.82 [95% CI 0.72 – 0.93], p = 0.01). Additionally, a PT ≤ 75 min was associated with a favorable outcome (adjusted OR 2.03[95% CI 1.26- 3.28]). The risk of complications and mortality increased by 0.5% and 1.5% with every 10 min increase in PT, respectively (R2 = 0.64 and R2 = 0.68, P <0.01). The cumulative rates of favorable outcomes and successful recanalization plateaued after 120 min (2 attempts). Restricted cubic spline regression analysis for the probability of favorable outcomes had an L-shape association (P non-linearity = 0.01) with PT with significant benefit loss before 120 min and then appeared relatively flat.
Discussion: For ABAO patients, procedures that exceeded 75 min were associated with an increased risk of mortality and lower odds of a favorable outcome. A careful assessment of futility and the risks of continuing the procedure should be made after 120 min.
- Received August 15, 2022.
- Accepted in final form March 23, 2023.
- © 2023 American Academy of Neurology
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