Background/Aims:
Acute basilar artery occlusion (BAO) is a time-critical high-morbidity, high-mortality stroke subtype. Non-focal signs and coma in BAO may delay stroke recognition and treatment. We compared stroke recognition and imaging metrics for anterior large vessel occlusion (aLVO) (intracranial internal carotid artery and M1 middle cerebral artery) and BAO stroke patients in a contemporary large single centre cohort.
Methods:
This retrospective cohort study used prospectively collected data on all admitted non-transferred Royal Adelaide Hospital adult LVO stroke patients (2018-2025). We compared Code Stroke activation frequency, reperfusion rates and timing metrics.
Results:
Of 13,477 total stroke admissions, 1,538 LVO patients were identified (119 BAO and 1419 aLVO), median NIHSS 11(IQR5-25)vs 16(IQR8-22) and age 74 (IQR65-82)vs 76(IQR65-85) years. Onset-arrival time in patients with BAO in comparison to aLVO was similar (101 minutes in BAO vs 97 minutes aLVO, p=0.316). Code Stroke activation frequency was also similar (85% BAO vs 90% aLVO, p=0.06).Arrival (‘door’)-imaging times for BAO patients were slower (32 vs 22 minutes, p<0.001), with prolonged door-needle (56 vs 45 minutes, p=0.04) and door-arterial puncture times (98 minutes vs 81 minutes, p=0.02). Thrombolysis (23% vs 20%, p=0.47) and thrombectomy rates (65% vs 60%, p=0.452) were similar.
Conclusion:
Patients with BAO had significantly longer door-to-imaging, door-to-needle and door-to-puncture times than with aLVO. This is potentially due to both delayed recognition and delays due to decreased conscious state. This study highlights a quality improvement opportunity.