Admission facility is associated with outcome of basilar artery occlusion

Stroke. 2007 Apr;38(4):1380-3. doi: 10.1161/01.STR.0000260089.17105.27. Epub 2007 Feb 22.


Background and purpose: Basilar artery occlusion (BAO) is a stroke subtype with poor prognosis, but recanalizing therapies have been reported to be effective. We investigated whether initial admission to telemedically linked general hospitals with subsequent stroke-center transfer is related to poorer outcome than direct admission to stroke centers.

Methods: All BAO cases of 3 stroke centers in Munich and 1 center in Regensburg between March 1, 2003 and December 31, 2004 were included, either if patients were directly admitted to stroke centers (n=23) or had initial admission to general hospitals of the telemedical network for integrative stroke care (TEMPiS) and secondary transfer to stroke centers (n=16). BAO was defined as angiographically (CTA, MRI or conventional angiography) confirmed occlusion of the basilar artery. Baseline parameters and therapeutic procedures were recorded. One-year follow-up was conducted prospectively.

Results: Differences in baseline parameters were not statistically significant. Time from onset to first angiography was significantly longer in patients with secondary transfer (mean: 355+/-93 minutes versus 222+/-198 minutes; P<0.01), mainly attributable to transfer duration (mean:156+/-73 minutes). In-hospital mortality (22% versus 75%; P<0.01) and 1-year-mortality (30% versus 81%; P<0.01) were lower for patients with direct admission to stroke centers. Fifty-two percent of directly admitted patients versus 13% of patients with secondary transfer (P=0.02) were living at home after 1 year.

Conclusions: BAO patients who were admitted primarily to community hospitals had a worse prognosis. Patients with typical symptoms should have direct access to stroke centers, or may need bridging therapies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers / standards
  • Academic Medical Centers / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital / standards*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Germany
  • Health Services Accessibility / standards
  • Health Services Accessibility / statistics & numerical data
  • Hospitals, General / standards
  • Hospitals, General / statistics & numerical data*
  • Humans
  • Intensive Care Units / standards
  • Intensive Care Units / statistics & numerical data
  • Male
  • Medicine / standards
  • Medicine / statistics & numerical data
  • Middle Aged
  • Patient Admission / standards
  • Patient Admission / statistics & numerical data
  • Patient Transfer / standards
  • Patient Transfer / statistics & numerical data
  • Prognosis
  • Quality of Health Care*
  • Specialization
  • Stroke / prevention & control
  • Stroke / therapy*
  • Telemedicine / standards*
  • Telemedicine / statistics & numerical data
  • Treatment Outcome
  • Vertebrobasilar Insufficiency / therapy*