Glasgow Coma Scale Does Not Predict Outcome Post-Intra-Arterial Treatment for Basilar Artery Thrombosis
Open Access
- 24 February 2011
- journal article
- Published by American Society of Neuroradiology (ASNR) in American Journal of Neuroradiology
- Vol. 32 (3), 576-580
- https://doi.org/10.3174/ajnr.a2325
Abstract
BACKGROUND AND PURPOSE: Evidence to guide patient selection for IA therapy in acute basilar artery thrombosis is lacking. The GCS is frequently used as a selection criterion, based on the view that higher GCS correlates with better neurologic outcome. This view has not been systematically studied. We hypothesize that low GCS does not correlate with poor outcome and that it should not preclude IA therapy. MATERIALS AND METHODS: We included 40 consecutive patients with basilar artery thrombosis treated with IA therapy. Clinical characteristics, GCS, time to intervention, and postprocedural TIMI scores were collected. Recanalization was defined as TIMI grade 2 or 3; clinical outcome was measured by 90-day mRS. RESULTS: Median patient age was 63.5 years. Most presented with gaze palsies (67.5%) or hemiparesis (45%). Median GCS was 9, the median time to intervention was 7.2 hours, and recanalization rate was 82.5%. Good neurologic outcome (mRS ≤ 1) occurred in 30%. There was no correlation between GCS and 90-day mRS (Spearman ρ − 0.174, P = .283). Equal numbers of patients with good neurologic outcome of mRS ≤ 1 (n = 12) had a GCS of ≤6 or >6. In those with GCS ≤ 6 for >3 hours, 33.3% had good neurologic outcome—a similar rate to that of the overall cohort. Statistical significance was demonstrated between time to IA therapy within 6 hours and mRS ≤ 2. CONCLUSIONS: Low GCS score did not correlate with poor neurologic outcome in patients with acute basilar artery thrombosis managed with IA therapy. It is not appropriate to exclude patients from IA therapy on the basis of low GCS.Keywords
This publication has 18 references indexed in Scilit:
- Therapy of Acute Basilar Artery OcclusionStroke, 2009
- Staged Escalation Therapy in Acute Basilar Artery OcclusionStroke, 2008
- Intra-Arterial Thrombolytic Therapy for Acute Basilar OcclusionStroke, 2007
- Therapy of Basilar Artery OcclusionStroke, 2006
- Results of a Multicentre, Randomised Controlled Trial of Intra-Arterial Urokinase in the Treatment of Acute Posterior Circulation Ischaemic StrokeCerebrovascular Diseases, 2005
- Endovascular Therapy of Acute Vertebrobasilar Occlusion: Early Treatment Onset as the Most Important FactorCerebrovascular Diseases, 2002
- Thrombolysis in the Vertebrobasilar Circulation: The Australian Urokinase Stroke TrialCerebrovascular Diseases, 1997
- Thrombolytic Therapy of Acute Basilar Artery OcclusionStroke, 1996
- Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease.Stroke, 1988
- Basilar artery occlusion: clinical and radiological correlation.Stroke, 1977