Basilar artery occlusion

UVOD: Okluzija bazilarne arterije uzrokuje 1% svih ishemijskih moždanih udara. Očituje se teškom kliničkom slikom u kojoj prevladavaju poremećaji svijesti, motorike i ispadi kranijalnih živaca. Neliječena okluzija bazilarne arterije ima visoku smrtnost koja seže i do 90%. Rekanalizacijsko liječenje uključuje primjenu intravenske trombolize alteplazom i/ili provedbu endovaskularne mehaničke trombektomije. ----- CILJ: Cilj rada jest pregledni prikaz literaturnih podataka etiologije, kliničkih specifičnosti i rezultata konzervativnog i endovaskularnog liječenja okluzije bazilarne arterije te retrospektivna analiza ishoda liječenja bolesnika Zavoda za intenzivno liječenje i cerebrovaskularne bolesti Klinike za neurologiju Kliničkog bolničkog centra Zagreb rekanalizacijskim metodama. ----- MATERIJAL I METODE: Proveli smo retrospektivnu analizu podataka 57 bolesnika s verificiranom okluzijom bazilarne arterije u razdoblju od veljače 2016. do listopada 2019. godine kod kojih je provedena rekanalizacijska terapija. Kao izvore podataka koristili smo Bolnički informacijski sustav (BIS), arhivirane zapise sa Zavoda za intenzivno liječenje i cerebrovaskularne bolesti te neuroslikovni materijal Zavoda za neuroradiologiju KBC-a Zagreb. Statistička analiza provedena je uz korištenje IBM SPSS 25 softvera. ----- REZULTATI: Mehanička trombektomija provedena je u 53 od 57 (93%) bolesnika uključenih u istraživanje, a intravenska tromboliza u njih 21 (36,8%). Uspješna rekanalizacija postignuta je u 64,9% (n=37) bolesnika. Dobar funkcionalni ishod (mRS 0-2) postignut je u 28,1% (n=16) bolesnika, a smrtnost je bila 52,6% (n= 30). Pokazalo se da je fibrilacija atrija jedini statistički značajan prediktor smrtnog ishoda u bolesnika (p= 0.016), dok je inicijalni NIHSS jedini statistički značajan prediktor za dobar funkcionalni ishod (p= 0.006). ----- ZAKLJUČAK: Provedba rekanalizacijskog liječenja smanjuje smrtnost od okluzije bazilarne arterije, međutim potrebno je provesti dodatna istraživanja koja će razjasniti kontroverzne rezultate u literaturi glede čimbenika koji utječu na ishod i smrtnost u tih bolesnika.INTRODUCTION: Basilar artery occlusion causes 1% of all ischemic strokes. It presents with severe clinical features, mostly with alteration in the level of consciousness, motor abnormalities and cranial nerves disorders. Untreated basilar artery occlusion has a high mortality, up to 90%. Recanalization treatment includes the use of intravenous thrombolysis and/or endovascular mechanical thrombectomy. ----- AIM: To review literature data on the etiology, clinical specifics and results of conservative and endovascular treatment of basilar artery occlusion. Simultaneously, a retrospective analysis of patient recanalization treatment outcomes at University Hospital Centre Zagreb (Neurology clinic, Department of Intensive Care and Cerebrovascular Diseases) was made. ----- MATERIAL AND METHODS: We conducted a retrospective data analysis of 57 patients with verified occlusion of the basilar artery in whom recanalization therapy was performed in the period from February 2016 to October 2019. We used the Hospital Information System, archived records from the Department of Intensive Care and Cerebrovascular Diseases and neuroimaging material of the Department of Neuroradiology at University Hospital Center Zagreb as data sources. Statistical analysis was performed using IBM SPSS 25 software. ----- RESULTS: Mechanical thrombectomy was performed in 53 out of 57 (93%) patients included in our study and intravenous thrombolysis in 21 (36.8%) patients. Successful recanalization was achieved in 64.9% (n= 37) of patients. Good functional outcome (mRS 0-2) was achieved in 28.1% (n= 16) of patients and mortality was 52.6% (n= 30). Atrial fibrillation was shown to be the only statistically significant predictor of mortality in patients (p= 0.016), while initial NIHSS was the only statistically significant predictor of good functional outcome (p= 0.006). ----- CONCLUSION: The implementation of recanalization treatment reduces mortality from basilar artery occlusion. However, additional research is needed to clarify conflicting results in the literature regarding factors influencing outcome and mortality in these patients