Skip to main content
 
Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

See our updated masking policy

Stanford Health Care

Recanalization of Basilar Artery Occlusion during Interhospital Transfer for Thrombectomy.

Recanalization of Basilar Artery Occlusion during Interhospital Transfer for Thrombectomy. International journal of stroke : official journal of the International Stroke Society Adwane, G., Lansberg, M. G., Liebart, S., Charbonneau, F., Schwartz, M. A., Heit, J. J., Mlynash, M., Sablot, D., Wacongne, A., Desilles, J., Costalat, V., Obadia, M., Henry, C., Manchon, E., Arquizan, C., Albers, G. W., Ter Schiphorst, A., Seners, P. 2025: 17474930251357739

Abstract

BACKGROUND: Patients with acute ischemic stroke and a large vessel occlusion admitted to non-endovascular capable centers frequently require interhospital transfer to a comprehensive stroke center (CSC) for thrombectomy. Data regarding arterial recanalization of patients with basilar artery occlusion (BAO) during transfer are lacking.METHODS: We analyzed prospectively collected data of acute stroke patients with BAO transferred for consideration of thrombectomy to three CSCs (Rothschild Hospital, France; Montpellier Hospital, France; Stanford Hospital, USA) between 2016 and 2024, with arterial imaging at the referring hospital and on CSC arrival. Interhospital recanalization was assessed by comparison of the baseline and post-transfer arterial imaging and was defined as 2a-3 on the mTICI scale. Independent predictors of interhospital recanalization were assessed using multivariable logistic regression analysis.RESULTS: Overall, 228 patients were included: median age 71 years, NIHSS 14, transfer time 3.5 hours, and 39% patients received intravenous thrombolysis (IVT) before transfer. The primary reason for withholding IVT was late presentation. Interhospital BAO recanalization occurred in 15% of patients. Variables independently associated with interhospital BAO recanalization were IVT use (aOR=24.3, 95%CI 6.9-85.5, P<0.01), distal BAO site (aOR=2.9, 1.0-8.5, P=0.05), lack of diabetes (aOR=11.4, 1.4-93.2, P=0.02) and non-atheromatous etiology (aOR=6.6, 1.4-31.4, P=0.02). BAO recanalization rates ranged from 1% in non-IVT treated patients with proximal BAO to 45% in IVT-treated patients with distal BAO. Interhospital recanalization was associated with an increased odds of good functional outcome (OR for 3-month mRS 0-2 = 3.3, 95%CI 1.2-8.8, P=0.02, adjusted for age, pre-stroke mRS, baseline NIHSS, pc-ASPECTS, IVT use and onset-to-imaging time).CONCLUSIONS: BAO recanalization during interhospital transfer for thrombectomy occurred in 15% of patients and was associated with favorable 3-month outcome. IVT use in the referring center was the primary modifiable factor associated with recanalization, yet its use remains low. Expanding IVT indications in primary stroke centers and developing new therapies that increase recanalization may improve outcomes.

View details for DOI 10.1177/17474930251357739

View details for PubMedID 40596745