Long Term Mortality, Disability and Stroke Recurrence in Patients with Basilar Artery Occlusion

Abstract

Background The long‐term outcomes and stroke recurrence after basilar artery occlusion (BAO) are largely unknown. We aimed to assess these variables in a comparatively large series of consecutive patients. Methods Adults with acute BAO were retrospectively identified from 1976 to 2011. Post‐discharge records were reviewed to assess for stroke recurrences, mortality and disability. Exploratory analysis of survival was carried out using Kaplan‐Meier and log‐rank tests. Factors associated with survival time were determined using Cox models. Results Eighty‐six patients, 34% female, median age 72 years (IQR 60‐79) with a median NIHSS of 11 (IQR 6‐27) were included. Twenty‐nine patients (34%) died during the initial hospitalization. Median mRS at discharge among survivors was 4 (IQR 2.5‐5.5). Among survivors 71% and 70% had a good outcome (mRS ≤3) at 1 and 5 years respectively. Seventeen patients had recurrent strokes during the hospitalization and 12 patients had 19 recurrent strokes after discharge. The median survival time was 52 (IQR 6‐1846) days. Older age per decade on admission (aHR=1.32, CI 1.05‐1.66, p=0.02) and a higher mRS at discharge (aHR=4.48, CI, 2.72‐7.39, p<0.0001) were associated with mortality. Patients who were not treated with any reperfusion therapy had a trend towards reduced mortality (aHR=0.39, CI 0.14‐1.08, p=0.07). Conclusions BAO survivors have severe short‐term functional disability. Most deaths and stroke recurrences occur within the first year following the initial event. The risk of death is higher in older and more disabled survivors. Yet, favorable long‐term recovery is possible.