Rehab Process and Need for Improved Guidelines of Basilar Artery Occlusions: Russell Cerejo, MD

WATCH TIME: 3 minutes

"The stroke community does realize that basilar occlusions and basilar occlusion circulation strokes are, as I said, one of the most disabling and on the most serious kinds of stroke. The guidelines do state that, up till now, mechanical thrombectomy could be tried for these patients. However, the trials were not very robust, and the data was not very conclusive."

Basilar artery occlusion is a potentially life-threatening subset of a larger category of posterior circulation strokes, carrying a greater than 80% fatality rate without treatment. Diagnosing BAO can be difficult because presenting symptoms are often nonfocal, such as headache, dizziness, and vertigo. Given that standard medical treatment alone is associated with insufficient recanalization rates and poor outcomes among patients with BAO, endovascular therapy has recently been regarded as a promising therapeutic approach for the condition.

Since 2006, several studies assessing the efficacy and safety of endovascular therapy have found suggested that this approach is effective in clinical outcomes and decreased mortalty; however, 2 trials—BASICS (NCT01717755) and BEST (NCT02441556)—did not find sufficient evidence of a difference in favorable outcomes. The symptoms associated with BAO can be abrupt, particularly in embolic and distal occlusions, but many patients with atherosclerotic and proximal occlusions experience prodromal symptoms. Notably, a near-complete recovery is possible if treatment is provided promptly.

Recently, NeurologyLive® sat down with Russell Cerejo, MD, vascular neurologist at Allegheny Health Network, to discuss the complexities of BAOs, and the need for improved consensus of treatment guidelines. Cerejo detailed the differences in therapeutic approaches and rehab for BAO in comparison with other strokes, as well as the increasing evidence of mechanical thrombectomy and its benefits.