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. 2024 Sep;9(3):575-582.
doi: 10.1177/23969873241234844. Epub 2024 Feb 25.

Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy

Thomas Accettone  1 , Thomas Personnic  2 , Martin Bretzner  2 , Helene Behal  3 , Charlotte Cordonnier  1 , Hilde Henon  1 , Laurent Puy  1
Affiliations

Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy

Thomas Accettone et al. Eur Stroke J. 2024 Sep.

Abstract

Introduction: Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome.

Patients and methods: Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes.

Results: Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, p = 0.002).

Discussion and conclusion: More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.

Keywords: Ischemic stroke; basilar artery occlusion; mechanical thrombectomy; prodromal symptoms.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.C. declares the following type of interests: speaker fees (Amgen and Bristol-Myers Squibb); Data And Safety Monitoring Board for Biogen and Bayer; grant funding from the French ministry of health (Programme Hospitalier de Recherche Clinique): A3ICH and TICH-3 Fr studies.Other authors: none.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Percentage breakdown of 90-day mRS score. mRS scores range from 0 (no disability) to 6 (death). Solid line indicates the gap between the proportion of mRS [0–3] between patients with and without prodromal symptoms. mRS: modified Rankin Scale.
See this image and copyright information in PMC

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