Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study

Research output: Contribution to journalArticle

Wouter J. Schonewille, Christine A C Wijman, Patrik Michel, Christina M. Rueckert, Christian Weimar, Heinrich P. Mattle, Stefan T. Engelter, David Tanne, Keith W. Muir, Carlos A. Molina, Vincent Thijs, Heinrich Audebert, Thomas Pfefferkorn, Kristina Szabo, Perttu J. Lindsberg, Gabriel de Freitas, L. Jaap Kappelle, Ale Algra, A. M. Weber, G. A. Donnan & 82 others V. Thijs, A. Peeters, G. de Freitas, A. B. Conforto, M. Miranda-Alves, A. Massaro, P. Ijäs, T. Bogoslovsky, P. J. Lindsberg, C. Weimar, J. Benemann, K. Kraywinkel, C. Haverkamp, D. Michalski, K. Weissenborn, M. Goertler, A. Kloth, A. Bitsch, T. Mieck, J. Machetanz, P. Möller, R. Huber, S. Kaendler, C. Rueckert, H. Audebert, R. Müller, B. Vatankhah, T. Pfefferkorn, T. E. Mayer, K. Szabo, C. Disque, O. Busse, C. Berger, W. Hacke, Y. Schwammenthal, D. Orion, D. Tanne, M. Bergui, E. Pozzati, W. J. Schonewille, A. Algra, L. J. Kappelle, G. J. Luijckx, P. Vroomen, M. D. Vergouwen, Y. Roos, J. Stam, P. Bienfait, F. E. de Leeuw, P. de Kort, D. Dippel, J. Pagola, M. Ribo, C. Molina, A. Gonzales, A. Gil-Peralta, B. Norrving, M. Arnold, U. Fischer, J. Gralla, H. Mattle, G. Schroth, P. Michel, S. T. Engelter, S. Wetzel, P. Lyrer, J. Gandjour, N. Michael, R. Baumgartner, B. Tettenborn, H. Hungerbuehler, T. Baird, K. Muir, C. A C Wijman, A. Finley Caulfield, M. Lansberg, N. Schwartz, C. Venkatasubramanian, Z. Garami, S. Bogaard, F. Yatzu, J. Grotta

Background: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. Methods: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. Findings: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0·94, 95% CI 0·60-1·45) or after IAT (adjusted RR 1·29, 0·97-1·72) but had a worse outcome after IAT compared with IVT (adjusted RR 1·49, 1·00-2·23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0·88, 0·76-1·01) or IAT (adjusted RR 0·94, 0·86-1·02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1·06, 0·91-1·22). Interpretation: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. Funding: Department of Neurology, University Medical Center Utrecht.

Original languageEnglish
Pages (from-to)724-730
Number of pages7
JournalThe Lancet Neurology
Volume8
Issue number8
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

PMID: 19577962

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Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS) : a prospective registry study. / Schonewille, Wouter J.; Wijman, Christine A C; Michel, Patrik; Rueckert, Christina M.; Weimar, Christian; Mattle, Heinrich P.; Engelter, Stefan T.; Tanne, David; Muir, Keith W.; Molina, Carlos A.; Thijs, Vincent; Audebert, Heinrich; Pfefferkorn, Thomas; Szabo, Kristina; Lindsberg, Perttu J.; de Freitas, Gabriel; Jaap Kappelle, L.; Algra, Ale; Weber, A. M.; Donnan, G. A.; Thijs, V.; Peeters, A.; de Freitas, G.; Conforto, A. B.; Miranda-Alves, M.; Massaro, A.; Ijäs, P.; Bogoslovsky, T.; Lindsberg, P. J.; Weimar, C.; Benemann, J.; Kraywinkel, K.; Haverkamp, C.; Michalski, D.; Weissenborn, K.; Goertler, M.; Kloth, A.; Bitsch, A.; Mieck, T.; Machetanz, J.; Möller, P.; Huber, R.; Kaendler, S.; Rueckert, C.; Audebert, H.; Müller, R.; Vatankhah, B.; Pfefferkorn, T.; Mayer, T. E.; Szabo, K.; Disque, C.; Busse, O.; Berger, C.; Hacke, W.; Schwammenthal, Y.; Orion, D.; Tanne, D.; Bergui, M.; Pozzati, E.; Schonewille, W. J.; Algra, A.; Kappelle, L. J.; Luijckx, G. J.; Vroomen, P.; Vergouwen, M. D.; Roos, Y.; Stam, J.; Bienfait, P.; de Leeuw, F. E.; de Kort, P.; Dippel, D.; Pagola, J.; Ribo, M.; Molina, C.; Gonzales, A.; Gil-Peralta, A.; Norrving, B.; Arnold, M.; Fischer, U.; Gralla, J.; Mattle, H.; Schroth, G.; Michel, P.; Engelter, S. T.; Wetzel, S.; Lyrer, P.; Gandjour, J.; Michael, N.; Baumgartner, R.; Tettenborn, B.; Hungerbuehler, H.; Baird, T.; Muir, K.; Wijman, C. A C; Finley Caulfield, A.; Lansberg, M.; Schwartz, N.; Venkatasubramanian, C.; Garami, Z.; Bogaard, S.; Yatzu, F.; Grotta, J.

In: The Lancet Neurology, Vol. 8, No. 8, 01.08.2009, p. 724-730.

Research output: Contribution to journalArticle

Harvard

Schonewille, WJ, Wijman, CAC, Michel, P, Rueckert, CM, Weimar, C, Mattle, HP, Engelter, ST, Tanne, D, Muir, KW, Molina, CA, Thijs, V, Audebert, H, Pfefferkorn, T, Szabo, K, Lindsberg, PJ, de Freitas, G, Jaap Kappelle, L, Algra, A, Weber, AM, Donnan, GA, Thijs, V, Peeters, A, de Freitas, G, Conforto, AB, Miranda-Alves, M, Massaro, A, Ijäs, P, Bogoslovsky, T, Lindsberg, PJ, Weimar, C, Benemann, J, Kraywinkel, K, Haverkamp, C, Michalski, D, Weissenborn, K, Goertler, M, Kloth, A, Bitsch, A, Mieck, T, Machetanz, J, Möller, P, Huber, R, Kaendler, S, Rueckert, C, Audebert, H, Müller, R, Vatankhah, B, Pfefferkorn, T, Mayer, TE, Szabo, K, Disque, C, Busse, O, Berger, C, Hacke, W, Schwammenthal, Y, Orion, D, Tanne, D, Bergui, M, Pozzati, E, Schonewille, WJ, Algra, A, Kappelle, LJ, Luijckx, GJ, Vroomen, P, Vergouwen, MD, Roos, Y, Stam, J, Bienfait, P, de Leeuw, FE, de Kort, P, Dippel, D, Pagola, J, Ribo, M, Molina, C, Gonzales, A, Gil-Peralta, A, Norrving, B, Arnold, M, Fischer, U, Gralla, J, Mattle, H, Schroth, G, Michel, P, Engelter, ST, Wetzel, S, Lyrer, P, Gandjour, J, Michael, N, Baumgartner, R, Tettenborn, B, Hungerbuehler, H, Baird, T, Muir, K, Wijman, CAC, Finley Caulfield, A, Lansberg, M, Schwartz, N, Venkatasubramanian, C, Garami, Z, Bogaard, S, Yatzu, F & Grotta, J 2009, 'Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study' The Lancet Neurology, vol. 8, no. 8, pp. 724-730. https://doi.org/10.1016/S1474-4422(09)70173-5

APA

Schonewille, W. J., Wijman, C. A. C., Michel, P., Rueckert, C. M., Weimar, C., Mattle, H. P., ... Grotta, J. (2009). Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. The Lancet Neurology, 8(8), 724-730. https://doi.org/10.1016/S1474-4422(09)70173-5

Vancouver

Schonewille WJ, Wijman CAC, Michel P, Rueckert CM, Weimar C, Mattle HP et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. The Lancet Neurology. 2009 Aug 1;8(8):724-730. https://doi.org/10.1016/S1474-4422(09)70173-5

Author

Schonewille, Wouter J. ; Wijman, Christine A C ; Michel, Patrik ; Rueckert, Christina M. ; Weimar, Christian ; Mattle, Heinrich P. ; Engelter, Stefan T. ; Tanne, David ; Muir, Keith W. ; Molina, Carlos A. ; Thijs, Vincent ; Audebert, Heinrich ; Pfefferkorn, Thomas ; Szabo, Kristina ; Lindsberg, Perttu J. ; de Freitas, Gabriel ; Jaap Kappelle, L. ; Algra, Ale ; Weber, A. M. ; Donnan, G. A. ; Thijs, V. ; Peeters, A. ; de Freitas, G. ; Conforto, A. B. ; Miranda-Alves, M. ; Massaro, A. ; Ijäs, P. ; Bogoslovsky, T. ; Lindsberg, P. J. ; Weimar, C. ; Benemann, J. ; Kraywinkel, K. ; Haverkamp, C. ; Michalski, D. ; Weissenborn, K. ; Goertler, M. ; Kloth, A. ; Bitsch, A. ; Mieck, T. ; Machetanz, J. ; Möller, P. ; Huber, R. ; Kaendler, S. ; Rueckert, C. ; Audebert, H. ; Müller, R. ; Vatankhah, B. ; Pfefferkorn, T. ; Mayer, T. E. ; Szabo, K. ; Disque, C. ; Busse, O. ; Berger, C. ; Hacke, W. ; Schwammenthal, Y. ; Orion, D. ; Tanne, D. ; Bergui, M. ; Pozzati, E. ; Schonewille, W. J. ; Algra, A. ; Kappelle, L. J. ; Luijckx, G. J. ; Vroomen, P. ; Vergouwen, M. D. ; Roos, Y. ; Stam, J. ; Bienfait, P. ; de Leeuw, F. E. ; de Kort, P. ; Dippel, D. ; Pagola, J. ; Ribo, M. ; Molina, C. ; Gonzales, A. ; Gil-Peralta, A. ; Norrving, B. ; Arnold, M. ; Fischer, U. ; Gralla, J. ; Mattle, H. ; Schroth, G. ; Michel, P. ; Engelter, S. T. ; Wetzel, S. ; Lyrer, P. ; Gandjour, J. ; Michael, N. ; Baumgartner, R. ; Tettenborn, B. ; Hungerbuehler, H. ; Baird, T. ; Muir, K. ; Wijman, C. A C ; Finley Caulfield, A. ; Lansberg, M. ; Schwartz, N. ; Venkatasubramanian, C. ; Garami, Z. ; Bogaard, S. ; Yatzu, F. ; Grotta, J. / Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS) : a prospective registry study. In: The Lancet Neurology. 2009 ; Vol. 8, No. 8. pp. 724-730.

BibTeX

@article{1a96ef63aa4f4ff8bacbbfaf724d57a9,
title = "Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study",
abstract = "Background: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. Methods: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. Findings: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68{\%}) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0·94, 95{\%} CI 0·60-1·45) or after IAT (adjusted RR 1·29, 0·97-1·72) but had a worse outcome after IAT compared with IVT (adjusted RR 1·49, 1·00-2·23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0·88, 0·76-1·01) or IAT (adjusted RR 0·94, 0·86-1·02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1·06, 0·91-1·22). Interpretation: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. Funding: Department of Neurology, University Medical Center Utrecht.",
author = "Schonewille, {Wouter J.} and Wijman, {Christine A C} and Patrik Michel and Rueckert, {Christina M.} and Christian Weimar and Mattle, {Heinrich P.} and Engelter, {Stefan T.} and David Tanne and Muir, {Keith W.} and Molina, {Carlos A.} and Vincent Thijs and Heinrich Audebert and Thomas Pfefferkorn and Kristina Szabo and Lindsberg, {Perttu J.} and {de Freitas}, Gabriel and {Jaap Kappelle}, L. and Ale Algra and Weber, {A. M.} and Donnan, {G. A.} and V. Thijs and A. Peeters and {de Freitas}, G. and Conforto, {A. B.} and M. Miranda-Alves and A. Massaro and P. Ij{\"a}s and T. Bogoslovsky and Lindsberg, {P. J.} and C. Weimar and J. Benemann and K. Kraywinkel and C. Haverkamp and D. Michalski and K. Weissenborn and M. Goertler and A. Kloth and A. Bitsch and T. Mieck and J. Machetanz and P. M{\"o}ller and R. Huber and S. Kaendler and C. Rueckert and H. Audebert and R. M{\"u}ller and B. Vatankhah and T. Pfefferkorn and Mayer, {T. E.} and K. Szabo and C. Disque and O. Busse and C. Berger and W. Hacke and Y. Schwammenthal and D. Orion and D. Tanne and M. Bergui and E. Pozzati and Schonewille, {W. J.} and A. Algra and Kappelle, {L. J.} and Luijckx, {G. J.} and P. Vroomen and Vergouwen, {M. D.} and Y. Roos and J. Stam and P. Bienfait and {de Leeuw}, {F. E.} and {de Kort}, P. and D. Dippel and J. Pagola and M. Ribo and C. Molina and A. Gonzales and A. Gil-Peralta and B. Norrving and M. Arnold and U. Fischer and J. Gralla and H. Mattle and G. Schroth and P. Michel and Engelter, {S. T.} and S. Wetzel and P. Lyrer and J. Gandjour and N. Michael and R. Baumgartner and B. Tettenborn and H. Hungerbuehler and T. Baird and K. Muir and Wijman, {C. A C} and {Finley Caulfield}, A. and M. Lansberg and N. Schwartz and C. Venkatasubramanian and Z. Garami and S. Bogaard and F. Yatzu and J. Grotta",
year = "2009",
month = "8",
day = "1",
doi = "10.1016/S1474-4422(09)70173-5",
language = "English",
volume = "8",
pages = "724--730",
journal = "The Lancet Neurology",
issn = "1474-4465",
publisher = "Lancet Publishing Group",
number = "8",

}

RIS

TY - JOUR

T1 - Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS)

T2 - The Lancet Neurology

AU - Schonewille, Wouter J.

AU - Wijman, Christine A C

AU - Michel, Patrik

AU - Rueckert, Christina M.

AU - Weimar, Christian

AU - Mattle, Heinrich P.

AU - Engelter, Stefan T.

AU - Tanne, David

AU - Muir, Keith W.

AU - Molina, Carlos A.

AU - Thijs, Vincent

AU - Audebert, Heinrich

AU - Pfefferkorn, Thomas

AU - Szabo, Kristina

AU - Lindsberg, Perttu J.

AU - de Freitas, Gabriel

AU - Jaap Kappelle, L.

AU - Algra, Ale

AU - Weber, A. M.

AU - Donnan, G. A.

AU - Thijs, V.

AU - Peeters, A.

AU - de Freitas, G.

AU - Conforto, A. B.

AU - Miranda-Alves, M.

AU - Massaro, A.

AU - Ijäs, P.

AU - Bogoslovsky, T.

AU - Lindsberg, P. J.

AU - Weimar, C.

AU - Benemann, J.

AU - Kraywinkel, K.

AU - Haverkamp, C.

AU - Michalski, D.

AU - Weissenborn, K.

AU - Goertler, M.

AU - Kloth, A.

AU - Bitsch, A.

AU - Mieck, T.

AU - Machetanz, J.

AU - Möller, P.

AU - Huber, R.

AU - Kaendler, S.

AU - Rueckert, C.

AU - Audebert, H.

AU - Müller, R.

AU - Vatankhah, B.

AU - Pfefferkorn, T.

AU - Mayer, T. E.

AU - Szabo, K.

AU - Disque, C.

AU - Busse, O.

AU - Berger, C.

AU - Hacke, W.

AU - Schwammenthal, Y.

AU - Orion, D.

AU - Tanne, D.

AU - Bergui, M.

AU - Pozzati, E.

AU - Schonewille, W. J.

AU - Algra, A.

AU - Kappelle, L. J.

AU - Luijckx, G. J.

AU - Vroomen, P.

AU - Vergouwen, M. D.

AU - Roos, Y.

AU - Stam, J.

AU - Bienfait, P.

AU - de Leeuw, F. E.

AU - de Kort, P.

AU - Dippel, D.

AU - Pagola, J.

AU - Ribo, M.

AU - Molina, C.

AU - Gonzales, A.

AU - Gil-Peralta, A.

AU - Norrving, B.

AU - Arnold, M.

AU - Fischer, U.

AU - Gralla, J.

AU - Mattle, H.

AU - Schroth, G.

AU - Michel, P.

AU - Engelter, S. T.

AU - Wetzel, S.

AU - Lyrer, P.

AU - Gandjour, J.

AU - Michael, N.

AU - Baumgartner, R.

AU - Tettenborn, B.

AU - Hungerbuehler, H.

AU - Baird, T.

AU - Muir, K.

AU - Wijman, C. A C

AU - Finley Caulfield, A.

AU - Lansberg, M.

AU - Schwartz, N.

AU - Venkatasubramanian, C.

AU - Garami, Z.

AU - Bogaard, S.

AU - Yatzu, F.

AU - Grotta, J.

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Background: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. Methods: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. Findings: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0·94, 95% CI 0·60-1·45) or after IAT (adjusted RR 1·29, 0·97-1·72) but had a worse outcome after IAT compared with IVT (adjusted RR 1·49, 1·00-2·23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0·88, 0·76-1·01) or IAT (adjusted RR 0·94, 0·86-1·02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1·06, 0·91-1·22). Interpretation: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. Funding: Department of Neurology, University Medical Center Utrecht.

AB - Background: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. Methods: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. Findings: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0·94, 95% CI 0·60-1·45) or after IAT (adjusted RR 1·29, 0·97-1·72) but had a worse outcome after IAT compared with IVT (adjusted RR 1·49, 1·00-2·23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0·88, 0·76-1·01) or IAT (adjusted RR 0·94, 0·86-1·02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1·06, 0·91-1·22). Interpretation: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. Funding: Department of Neurology, University Medical Center Utrecht.

UR - http://www.scopus.com/inward/record.url?scp=67650073225&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650073225&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(09)70173-5

DO - 10.1016/S1474-4422(09)70173-5

M3 - Article

VL - 8

SP - 724

EP - 730

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4465

IS - 8

ER -

ID: 2953433