The data on long-term outcome after basilar artery occlusion (BAO) are scarce. Only a little is known about BAO survivors´ outcome over decades.
We set out to investigate long-term survival and causes of death in BAO patients with up to two-decade follow-up. We also evaluated differences in outcome trends.
207 BAO patients treated with intravenous thrombolysis (IVT) at the Department of Neurology, Helsinki University Hospital, between 1995-2016 were analyzed. Short-term outcome was assessed with modified Rankin Scale (mRS) at three months. Long-term cumulative survival rate was analyzed using Kaplan-Meier analysis. Factors associated with mortality were analyzed with Cox regression.
Moderate outcome (mRS 0-3) was achieved in 41.1% and good outcome (mRS 0-2) in 30.4% of patients at three months. Three-month mortality was 39.6%, of which 89% died within first month. The median follow-up time in 3-month survivors was 8.9 years (max. 21.8 years). Total mortality during the follow-up was 52.2%. Cumulative mortality rate was 25.7%. Older age, coronary artery disease and more extensive ischemic changes on admission brain imaging were independently associated with long-term mortality. After the acute phase, the rate of other vascular causes of death increased in relation to stroke.
The described evolution of a large single-center BAO cohort shows a trend towards higher rate of good and/or moderate outcome during later years in IVT-treated patients. Survivors showed relative longevity and the rate of cardiac and other vascular causes of death increased in relation to stroke sequelae over long term.

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