Extended Thrombolysis In Cerebral Infarction (eTICI) grade 2c: a potential angiographic target for endovascular treatment in acute basilar artery occlusion?

2021 ◽  
pp. neurintsurg-2021-018026
Author(s):  
Luming Chen ◽  
Chenghao Zhao ◽  
Jiaxing Song ◽  
Wenjie Zi ◽  
Hongfei Sang ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Intracranial Hemorrhage ◽  
Basilar Artery ◽  
Functional Outcomes ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Impact

BackgroundHigher extended Thrombolysis In Cerebral Infarction (eTICI) grades are associated with better clinical outcomes after endovascular treatment (EVT) for proximal intracranial occlusion of the anterior circulation. However, the relationship between eTICI grade and outcomes after EVT in patients with acute basilar artery occlusion (BAO) remains unclear. We aimed to explore which eTICI category was the cut-off correlating with better clinical outcomes in patients with BAO undergoing EVT.MethodsWe included patients treated via EVT from the BASILAR study. Multivariable logistic regression analyses were performed to assess the impact of eTICI grades on 90-day favorable functional outcomes, defined as a modified Rankin Scale (mRS) score of 0–3. Other outcomes were functional independence (mRS 0–2), all-cause mortality, and symptomatic intracranial hemorrhage.ResultsAmong 647 patients treated with EVT, 127 (19.6%), 128 (24.5%), 110 (21.1%), and 282 (54%) patients achieved eTICI grades of 0–2a, 2b, 2c, and 3, respectively. Compared with eTICI grades 0–2a, higher rates of favorable functional outcomes (adjusted OR (aOR) 2.96, 95% CI 1.33 to 6.57, and aOR 7.40, 95% CI 3.63 to 15.09, respectively) were observed for grades 2c and 3, not 2b (aOR 1.93, 95% CI 0.86 to 4.36). The risks of mortality and symptomatic intracranial hemorrhage were also lower for eTICI grades 2c and 3 than for grades 0–2a.ConclusionsAn eTICI grade of 2c/3 may be a target for successful reperfusion after EVT in patients with acute BAO; however, further studies with larger sample sizes and clinical trials are needed.

scholarly journals Intracranial Stenting as Rescue Therapy After Failure of Mechanical Thrombectomy for Basilar Artery Occlusion: Data From the ANGEL-ACT Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Gang Luo ◽  
Feng Gao ◽  
Xuelei Zhang ◽  
Baixue Jia ◽  
Xiaochuan Huo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Intracranial Hemorrhage ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Studies on rescue therapy for acute posterior circulation stroke due to basilar artery occlusion (BAO) are limited in the modern era of mechanical thrombectomy (MT). The aim of this study was to evaluate the safety and efficacy of rescue stenting (RS) following MT failure in patients with BAO.Methods: Data were collected from the Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) prospective registry in China. Patients who underwent MT for BAO with failure of recanalization were enrolled in this study. The patients were divided into the RS and non-RS groups. Clinical and laboratory findings, procedural details, and clinical outcomes were compared between the two groups.Results: Overall, 93 patients with acute BAO were analyzed. The RS group included 81 (87.1%) patients, and the non-RS group included 12 patients. A modified treatment in cerebral infarction (mTICI) score of 2b/3 was achieved in 75 (92.6%) patients in the RS group. Compared with the non-RS group, the RS group had a significantly higher rate of successful recanalization and favorable clinical outcomes (modified Rankin Scale score at 90 days post-procedure, 0–3: 16.7 vs. 51.9%, respectively; P = 0.023) without an increase in the rate of symptomatic intracranial hemorrhage and a significantly lower mortality rate (58.3 vs. 18.5%, respectively; P = 0.006). Furthermore, the use of a glycoprotein IIb/IIIa inhibitor improved the rate of recanalization of the target artery without increasing the rate of symptomatic intracranial hemorrhage.Conclusions: Permanent stenting appears to be a feasible rescue modality when MT fails and might provide functional benefits in patients with acute ischemic stroke due to BAO.

Abstract 1122‐000068: Basilar Artery Occlusion Thrombectomy Between Evidence Based Medicine and the Real‐World Practice, Single Centre Experience

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Islam El Malky ◽  
Ali Hendi ◽  
Hazem Abdelkhalek
Keyword(s):  
Clinical Outcome ◽  
Intracranial Hemorrhage ◽  
Basilar Artery ◽  
Real World ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Early Reperfusion ◽  
Good Outcome ◽  
Symptomatic Intracranial Hemorrhage ◽  
Multiple Variables

Introduction : BAO (basilar artery occlusion) is well known by catastrophic outcomes whether death or disability in approximately 70 %. 1 Thrombectomy as an intervention in large vessel occlusion of anterior proximal circulation was approved after multiple RCTs and meta‐analyses. 2 In spite of two RCTs that appeared lately, there is still uncertainty about the effect of thrombectomy in BAO. 9, 10 Our study aims to report the outcome of BAO, as a further clue of MT effectiveness in BAO and variables affecting good outcome and mortality rate. Methods : We retrospectively collected the clinical and radiological data of 30 BAO patients treated in our center between 2016 and 2020. There is no limitation as regard age or presenting NIHHS. Twenty‐two patients who came to the emergency within 4.5 hours had I.V. thrombolytic therapy (73.3%). A favorable clinical outcome was considered if mRS ≤ 2. Angioplasty, stenting, or I.A thrombolysis were used as a rescue treatment. Symptomatic intracranial hemorrhage within two days after the initiation of treatment and mortality at 90 days were reported. The radiological outcome was assessed by modified Thrombolysis in Cerebral Infarction (mTICI) score where mTICI ≥ 2b or 3 at the end of the intervention was considered a favorable radiological result. Multiple variables were tested for their effect on favorable clinical outcomes and mortality (Table 1). Results : Among 30 patients, the mean age was 61.23 ± 16.81 years; 20/30 (66.7%) male. A favorable functional outcome was achieved in (40.7%). Successful revascularization was achieved in 26 patients (86.7 %). Four patients had procedural complications (13.3%). Symptomatic intracranial hemorrhage occurred in three cases (11%) and mortality at 90 days was 11 patients (36.7 %). The presenting NIHSS is the only predictor of mortality and the optimal cut‐off value for death was 15 with AUC = 0.758 (sensitivity 91 % and specificity 59%) and p‐value = 0.02. TOR (time of onset to recanalization) had no effect on the clinical outcome which is controversy with the paradigm of early reperfusion leading to a good outcome Conclusions : In spite of two RCSs approved no statistical difference between medical treatment and thrombectomy, thrombectomy is still an effective procedure in real‐world practice in selected cases. The presenting NIHSS is the only predictor of mortality in our studies. More studies are warranted to discover other predictors of BAO thrombectomy outcome to improve case selection and avoid futile recanalization.

scholarly journals Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion

2021 ◽  
pp. svn-2021-001242
Author(s):  
Ximing Nie ◽  
David Wang ◽  
Yuehua Pu ◽  
Yufei Wei ◽  
Qixuan Lu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Basilar Artery ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Lower Percentage ◽  
Basilar Artery Occlusion

Background and purposeIt remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO.MethodsPatients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO.ResultsOf 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01).ConclusionsThis study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion

2021 ◽  
pp. 174749302110522
Author(s):  
Gabriel Broocks ◽  
Tobias D Faizy ◽  
Lukas Meyer ◽  
Maximilian Groffmann ◽  
Sarah Elsayed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Poor Outcomes ◽  
The Impact

Background In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. Aim This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. Methods In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0–2 at day 90). Results A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25–16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9–5.8). Conclusion PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.

Endovascular Treatment for Acute Basilar Artery Occlusion: A Nationwide Prospective Registry

2019 ◽  
Author(s):  
Wenjie Zi ◽  
Zhongming Qiu ◽  
Deping Wu ◽  
Fengli Li ◽  
Hansheng Liu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

Abstract P478: One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Fengli Li ◽  
Hongfei Sang ◽  
Jiaxing Song ◽  
Zhangbao Guo ◽  
Shuai Liu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Conventional Treatment ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Treatment Groups ◽  
Excellent Outcome ◽  
Follow Up Study

Background and Objective: To report the results of clinical follow-up at 1 year among patients in the BASILAR registry. Design, Setting, and Participants: The BASILAR study was an investigator-initiated prospective registry, which consecutively enrolled stroke patients with acute basilar artery occlusion from 47 comprehensive stroke centers in China between January, 2014, and May, 2019. Patients were divided into conventional treatment or endovascular treatment groups according to the treatment their received. We assessed clinical outcomes 1 year after patients were enrolled in the BASILAR registry. Main Outcomes and Measures: The primary outcome was the score on the modified Rankin scale (range, 0 to 6 points, with higher scores indicating more severe disability) at 1 year assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. Secondary outcomes included categories scores of the modified Rankin scale at 1 year (0 to 1 [excellent outcome], 0 to 2 [good outcome], and 0 to 3 [favorable outcome]), and death from any cause during the 1-year period after enrollment. Results: Of the 829 patients who were enrolled in the original study, 1-year data for this extended follow-up study were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin scale favored endovascular treatment over conventional treatment (adjusted common odds ratio, 4.50; 95% confidence interval [CI], 2.81 to 7.29; P < 0.001). There were significant differences between the treatment groups in the percentage of patients who had excellent outcome, good outcome and favorable outcome. The cumulative 1-year mortality rate was 54.6% in the endovascular treatment group and 83.5% in the conventional treatment group (adjusted hazard ratio, 4.36; 95% CI, 2.69 to 7.29; P < 0.001). Conclusions and Relevance: In this extended follow-up study, the beneficial effect of endovascular treatment on functional outcome at 1 year in patients with acute basilar artery occlusion was similar to that reported at 90 days in the original study.

scholarly journals The history of basilar artery occlusion: when art aids science

2018 ◽  
Vol 76 (5) ◽  
pp. 355-357
Author(s):  
Francisco Antunes Dias ◽  
Daniel Giansante Abud ◽  
Octavio Marques Pontes-Neto
Keyword(s):  
Basilar Artery ◽  
Rare Condition ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
High Morbidity ◽  
Medical Sciences ◽  
Randomized Controlled ◽  
History Of ◽  
The Impact

ABSTRACT Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.

scholarly journals One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽  
2021 ◽  
Author(s):  
Fengli Li ◽  
Hongfei Sang ◽  
Jiaxing Song ◽  
Zhangbao Guo ◽  
Shuai Liu ◽  
...  
Keyword(s):  
Treatment Group ◽  
Endovascular Treatment ◽  
Basilar Artery ◽  
Odds Ratio ◽  
Conventional Treatment ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Common Odds Ratio ◽  
One Year

Background and Purpose: The BASILAR registry, a nationwide prospective nonrandomized study conducted in China, enrolled consecutive patients with acute basilar artery occlusion receiving endovascular treatment or conventional-treatment from January 2014 to May 2019. This article aimed to report the results of clinical follow-up at one year among these patients. Methods: The primary outcome was the modified Rankin Scale at one year, assessed as a common odds ratio using ordinal logistic regression analysis adjusted for prespecified prognostic factors. Secondary outcomes included the modified Rankin Scale-based outcome group at one year (0–1, 0–2, or 0–3) and all-cause death. Results: Of the 829 patients enrolled in the original BASILAR registry, one-year data were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin Scale favored endovascular treatment over conventional-treatment (adjusted common odds ratio, 4.50 [95% CI, 2.81–7.29]; P <0.001). The cumulative one-year mortality rate was 54.6% in the endovascular treatment group versus 83.5% in the conventional-treatment group (adjusted odds ratio, 4.36 [95% CI, 2.69–7.29]; P <0.001). Conclusions: The beneficial effect of endovascular treatment on functional outcome at one year in patients with acute basilar artery occlusion is similar to that reported at 90 days in the original study. REGISTRATION: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR1800014759.

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