ABSTRACT
Objective: To investigate the feasibility of performing endovascular recanalization therapy (ERT) in patients with acute basilar artery occlusion (BAO) of broadened time window (≥24 hours) based on clinical-diffusion mismatch (CDM). Methods: A total of 11 CDM patients whose Glasgow Coma Scale (GCS) score <8 at admission were recruited and the diffusion-weighted imaging (DWI) did not find their brainstem reticular formation and bilateral damage to hypothalamus. Intra-arterial thrombolysis (IAT) with rt-PA alone or in combination with IAT, percutaneous transluminal angioplasty (PTA) and stenting were used. At the same time, the degree of recanalization was evaluated according to the thrombolysis in myocardial infarction (TIMI) criteria and the complications were observed. The modified Rankin scale (mRS) was used to assess after 3 months. Results: Circled digit oneThe mean onset time and duration of coma of the 11 patients were 42 hours (range 25 to 73 hours) and 11 hours (range 2 to 24 hours), respectively. The mean GCS score at admission was 6 (range 3 to 7) and that was 14 (range 3 to 15) at discharge. Circled digit twoNine patients performed ERT successfully (n = 2, TIMI grade 2, n = 7, TIMI grade 3) and 2 failed (TIMI 0). There were no complications such as bleeding. The patients regained consciousness within 9 to 27 hours. Circled digit threeThe patients were followed up after 3 months, 7 had good outcome (mRS, 0 to 2) and 2 had poor outcome (mRS, 3). ERT failed in 2 patients and they died at day 5 and day 21 after the procedures. Conclusion: The patients with broadened time window on CDM who performed ERT may have a higher recanalization rate and relatively good clinical outcome. The patients with collateral circulation has good outcome.