{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:41:12Z","timestamp":1760125272738,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T00:00:00Z","timestamp":1679184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Basilar artery occlusion (BAO) is associated with high morbidity and mortality. Endovascular therapy (EVT) has been shown to be beneficial in acute BAO patients. This retrospective observational study used the National Inpatient Sample (NIS) database to identify BAO patients using the International Classification of Diseases (ICD). Multivariable models were used to evaluate the association of risk factors, comorbidities, length of stay (LOS) in hospital, total cost, disposition, and transfer status. A total of 1120 (447 females, 39.95%) patients were identified, with a higher proportion of White individuals (66.8% vs. 57.6%), atrial fibrillation (31.5% vs. 17.2%; p &lt; 0.0001), and peripheral vascular disease (21.2% vs. 13.7%; p = 0.009). A lower proportion of individuals with diabetes mellitus (32.1% vs. 39.5%; p = 0.05) was found in the EVT group. Majority of the patients (924\/1120, 82.5%) were treated at the urban teaching facility, which also performed most of the EVT procedures (164, 89.13%), followed by non-academic urban (166, 14.8%) and rural (30, 2.7%) hospitals. Most patients (19\/30, 63%) admitted to rural hospitals were transferred to other facilities. Urban academic hospitals also had the highest median LOS (8.9 days), cost of hospitalization (USD 117,261), and disposition to home (32.6%). This study observed distinct patterns and geographical disparities in the acute treatment of BAO patients. There is a need for national- and state-level strategies to improve access to stroke care.<\/jats:p>","DOI":"10.3390\/life13030829","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T06:48:35Z","timestamp":1679294915000},"page":"829","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Patterns of Care in Patients with Basilar Artery Occlusion (BAO): A Population-Based Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3697-5697","authenticated-orcid":false,"given":"Mudassir","family":"Farooqui","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asad","family":"Ikram","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sajid","family":"Suriya","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of New Mexico Health Science Center, Albuquerque, NM 87106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3376-220X","authenticated-orcid":false,"given":"Fares","family":"Qeadan","sequence":"additional","affiliation":[{"name":"Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"Bzdyra","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Bernardine Medical Center, San Bernadino, CA 92404, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed A.","family":"Quadri","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Cincinnati, Cincinnati, OH 45221, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atif","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Michael Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart disease and stroke statistics\u20142020 update: A report from the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1161\/STR.0b013e31829734f2","article-title":"Forecasting the future of stroke in the United States: A policy statement from the American Heart Association and American Stroke Association","volume":"44","author":"Ovbiagele","year":"2013","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/S1474-4422(11)70229-0","article-title":"Basilar artery occlusion","volume":"10","author":"Mattle","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/S1474-4422(09)70173-5","article-title":"Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): A prospective registry study","volume":"8","author":"Schonewille","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S1474-4422(19)30395-3","article-title":"Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): An open-label, randomised controlled trial","volume":"19","author":"Liu","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1056\/NEJMoa2030297","article-title":"Endovascular therapy for stroke due to basilar-artery occlusion","volume":"384","author":"Langezaal","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995). Tissue Plasminogen Activator for Acute Ischemic Stroke. N. Engl. J. Med., 333, 1581\u20131588.","DOI":"10.1056\/NEJM199512143332401"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/j.1552-6569.2009.00462.x","article-title":"Thrombolysis in anterior versus posterior circulation strokes: Timing of recanalization, ischemic tolerance, and other differences","volume":"21","author":"Pagola","year":"2011","journal-title":"J. Neuroimaging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1136\/neurintsurg-2014-011418","article-title":"Recanalization of acute basilar artery occlusion improves outcomes: A meta-analysis","volume":"7","author":"Kumar","year":"2015","journal-title":"J. Neurointerventional Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2480","DOI":"10.1001\/jama.2013.6959","article-title":"Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke","volume":"309","author":"Saver","year":"2013","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1161\/STROKEAHA.120.028850","article-title":"Endovascular thrombectomy for acute ischemic strokes: Current US access paradigms and optimization methodology","volume":"51","author":"Sarraj","year":"2020","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1136\/neurintsurg-2016-012824","article-title":"Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke","volume":"9","author":"Rinaldo","year":"2017","journal-title":"J. Neurointerv. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1161\/CIRCULATIONAHA.117.028920","article-title":"Interhospital transfer before thrombectomy is associated with delayed treatment and worse outcome in the STRATIS registry (systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke)","volume":"136","author":"Froehler","year":"2017","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1001\/archneur.65.7.887","article-title":"Rural-urban differences in acute stroke management practices: A modifiable disparity","volume":"65","author":"Leira","year":"2008","journal-title":"Arch. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1212\/WNL.0000000000003562","article-title":"Progressive rural\u2013urban disparity in acute stroke care","volume":"88","author":"Gonzales","year":"2017","journal-title":"Neurology"},{"key":"ref_17","unstructured":"The Agency for Healthcare Research and Quality (2022, July 05). HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP), Available online: https:\/\/www.hcup-us.ahrq.gov\/db\/nation\/nis\/NIS_2007_INTRODUCTION.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"147","author":"Altman","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3019","DOI":"10.1161\/STROKEAHA.114.006293","article-title":"Geographic access to acute stroke care in the United States","volume":"45","author":"Adeoye","year":"2014","journal-title":"Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3295","DOI":"10.1161\/STROKEAHA.117.018149","article-title":"Mobile interventional stroke teams lead to faster treatment times for thrombectomy in large vessel occlusion","volume":"48","author":"Wei","year":"2017","journal-title":"Stroke"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.1007\/s00415-021-10948-1","article-title":"Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion","volume":"269","author":"Broocks","year":"2022","journal-title":"J. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1756286420981354","DOI":"10.1177\/1756286420981354","article-title":"HbA1c and clinical outcomes after endovascular treatment in patients with posterior circulation large vessel occlusion: A subgroup analysis of a nationwide registry (BASILAR)","volume":"13","author":"Yue","year":"2020","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e009419","DOI":"10.1161\/JAHA.118.009419","article-title":"Endovascular thrombectomy for acute basilar artery occlusion: A multicenter retrospective observational study","volume":"7","author":"Kang","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.3389\/fneur.2021.731300","article-title":"Predictors of functional outcome and mortality in endovascular treatment for acute basilar artery occlusion: A single-centre experience","volume":"12","author":"Cao","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1177\/2396987316629889","article-title":"Recanalization treatments in basilar artery occlusion\u2014Systematic analysis","volume":"1","author":"Lindsberg","year":"2016","journal-title":"Eur. Stroke J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1161\/STROKEAHA.108.526566","article-title":"Therapy of acute basilar artery occlusion: Intraarterial thrombolysis alone vs bridging therapy","volume":"40","author":"Nagel","year":"2009","journal-title":"Stroke"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"211","DOI":"10.5853\/jos.2016.00031","article-title":"A comparison between mechanical thrombectomy and intra-arterial fibrinolysis in acute basilar artery occlusion: Single center experiences","volume":"18","author":"Jung","year":"2016","journal-title":"J. Stroke"},{"key":"ref_28","first-page":"2042","article-title":"Outcome of acute vertebrobasilar occlusions treated with intra-arterial fibrinolysis in 180 patients","volume":"27","author":"Hamann","year":"2006","journal-title":"Am. J. Neuroradiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.3171\/2015.4.JNS141631","article-title":"Impact of transfer status on hospitalization cost and discharge disposition for acute ischemic stroke across the US","volume":"124","author":"Sonig","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1411587","article-title":"A randomized trial of intraarterial treatment for acute ischemic stroke","volume":"372","author":"Berkhemer","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1056\/NEJMoa1414905","article-title":"Randomized assessment of rapid endovascular treatment of ischemic stroke","volume":"372","author":"Goyal","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1056\/NEJMoa1503780","article-title":"Thrombectomy within 8 hours after symptom onset in ischemic stroke","volume":"372","author":"Jovin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1056\/NEJMoa1415061","article-title":"Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke","volume":"372","author":"Saver","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1056\/NEJMoa1414792","article-title":"Endovascular therapy for ischemic stroke with perfusion-imaging selection","volume":"372","author":"Campbell","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1706442","article-title":"Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct","volume":"378","author":"Nogueira","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1056\/NEJMoa1713973","article-title":"Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging","volume":"378","author":"Albers","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Writing Group for the BASILAR Group, Zi, W., Qiu, Z., Wu, D., Li, F., Liu, H., Liu, W., Huang, W., Shi, Z., and Bai, Y. (2020). Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurol., 77, 561\u2013573.","DOI":"10.1001\/jamaneurol.2020.0156"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1161\/CIRCULATIONAHA.121.058544","article-title":"Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry","volume":"146","author":"Tao","year":"2022","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3410","DOI":"10.1161\/STROKEAHA.121.035948","article-title":"Endovascular therapy for stroke due to basilar artery occlusion: A BASIC challenge at BEST","volume":"52","author":"Nguyen","year":"2021","journal-title":"Stroke"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1056\/NEJMoa2207576","article-title":"Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion","volume":"387","author":"Jovin","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1056\/NEJMoa2206317","article-title":"Trial of endovascular treatment of acute basilar-artery occlusion","volume":"387","author":"Tao","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1177\/1591019916678199","article-title":"Availability of endovascular therapies for cerebrovascular disease at primary stroke centers","volume":"23","author":"Alberts","year":"2017","journal-title":"Interv. Neuroradiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1161\/STROKEAHA.113.003071","article-title":"Design and validation of a prehospital stroke scale to predict large arterial occlusion: The rapid arterial occlusion evaluation scale","volume":"45","author":"Carrera","year":"2014","journal-title":"Stroke"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2264","DOI":"10.1161\/STROKEAHA.107.508127","article-title":"A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions","volume":"39","author":"Nazliel","year":"2008","journal-title":"Stroke"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1161\/STROKEAHA.115.008804","article-title":"Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale","volume":"46","author":"Katz","year":"2015","journal-title":"Stroke"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1161\/STROKEAHA.115.012482","article-title":"Prehospital acute stroke severity scale to predict large artery occlusion: Design and comparison with other scales","volume":"47","author":"Hastrup","year":"2016","journal-title":"Stroke"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.11.014","article-title":"Design, application and infield validation of a pre-hospital emergent large vessel occlusion screening tool: Ventura emergent large vessel occlusion score","volume":"28","author":"Taqi","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/3\/829\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:58:35Z","timestamp":1760122715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/3\/829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,19]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["life13030829"],"URL":"https:\/\/doi.org\/10.3390\/life13030829","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2023,3,19]]}}}