Abstract Details

Population-level data for patients with AIS associated with BAO is sparse due to the rarity of this condition.

To evaluate risk factors, treatment patterns, and outcomes after acute ischemic stroke (AIS) associated with basilar artery occlusion (BAO) strokes.

Adults ages 18+ admitted to U.S. hospitals in the Nationwide Inpatient Sample from 2005-2017 with a primary diagnosis of AIS were identified by ICD-9/10 CM codes. National estimates were generated using discharge weights. BAO in any diagnosis position was extracted (ICD-9 433.01; ICD-10 I63.22). Demographic and clinical characteristics of AIS patients with and without BAO were compared. Adjusted multivariable logistic regression models were built to determine associations between BAO and acute stroke therapy utilization, discharge disposition, and in-hospital mortality.  

We included 29,412 (0.5%) BAO-associated AIS hospitalizations. BAO AIS patients were more likely to be younger (mean age 66.9 vs. 70.7 years, p<0.0001), male (58.7% vs. 47.4%, p-value<0.0001), non-White race (36.5% vs. 30.7%, p<0.0001), have atrial fibrillation (3.3% vs 2.5%, p<0.0001), use drugs (3.29% vs 2.53%, p=0.0041), and have a lower Charlson comorbidity index (mean 2.4 vs 2.5, p-value <0.0001). Hypertension and diabetes frequencies were similar. AIS patients with BAO were more likely to be treated with IV-tPA (OR 2.3; 95% C.I. 2.05-2.49) and thrombectomy (OR 7.3; 95% C.I. 6.52-8.20). BAO AIS patients were more likely to die during hospitalization (OR 2.41; 95% C.I. 2.23–2.59) and less likely to be discharged home (OR 0.56; 95% C.I. 0.52-0.60).

BAO strokes are rare, and risk factors include younger age, male sex, non-White race, atrial fibrillation, and drug use. BAO AIS patients were more likely to receive acute stroke therapy. Adjusting for demographics, comorbidities, and treatment strategy, AIS patients with BAO had worse outcomes. Further study is necessary to optimize outcomes for AIS patients with BAO.