Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to 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.

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Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012089 ◽

2015 ◽

Vol 8 (11) ◽

pp. 1107-1115 ◽

Cited By ~ 35

Author(s):

Kevin Phan ◽

Steven Phan ◽

Ya Ruth Huo ◽

Fangzhi Jia ◽

Alex Mortimer

Keyword(s):

Systematic Review ◽

Endovascular Treatment ◽

Basilar Artery ◽

Meta Analysis ◽

Functional Independence ◽

Artery Occlusion ◽

Stent Retriever ◽

High Rate ◽

Basilar Artery Occlusion ◽

Anterior Circulation

BackgroundStent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear.ObjectiveTo carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO.MethodsTwo independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO.ResultsA total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59–82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0–88%) and 38% (range 0–90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b–3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively.ConclusionsStent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted.

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Endovascular clot retrieval for acute ischaemic stroke due to basilar artery occlusion in childhood

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14449 ◽

2020 ◽

Vol 62 (10) ◽

pp. 1221-1223 ◽

Cited By ~ 1

Author(s):

Emma Macdonald‐Laurs ◽

Jason Wenderoth ◽

Michael Cardamone ◽

Hugo Sampaio ◽

P Ian Andrews

Keyword(s):

Ischaemic Stroke ◽

Basilar Artery ◽

Acute Ischaemic Stroke ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018026 ◽

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.

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DWI cerebellar infarct volume as predictor of outcomes after endovascular treatment of acute basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016804 ◽

2020 ◽

pp. neurintsurg-2020-016804

Author(s):

Isabelle Mourand ◽

Mehdi Mahmoudi ◽

Cyril Dargazanli ◽

Frederique Pavillard ◽

Caroline Arquizan ◽

...

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Roc Analysis ◽

Independent Predictor ◽

Infarct Volume ◽

Functional Independence ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Risk Of Death ◽

Cerebellar Infarct

BackgroundPreprocedural predictors of outcome in patients with acute basilar artery occlusion (ABAO) who have undergone endovascular treatment (EVT) remain controversial. Our aim was to determine if pre-EVT diffusion-weighted imaging cerebellar infarct volume (CIV) is a predictor of 90-day outcomes.MethodsWe analyzed consecutive MRI-selected endovascularly treated patients with ABAO within the first 24 hours after symptom onset. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction score of 2b–3. Using the initial MRI, baseline CIV was calculated in mL on an apparent diffusion coefficient map reconstruction (Olea Sphere software). CIV was analyzed in univariate and multivariable models as a predictor of 90-day functional independence (modified Rankin Scale (mRS) 0–2) and mortality. According to receiver operating characteristic (ROC) analysis, the optimal cut-off was determined by maximizing the Youden index to evaluate the prognostic value of CIV.ResultsOf the 110 MRI-selected patients with ABAO, 64 (58.18%) had a cerebellar infarct. The median CIV was 9.6 mL (IQR 2.7–31.4). Successful reperfusion was achieved in 81.8% of the cases. At 90 days the proportion of patients with mRS ≤2 was 31.8% and the overall mortality rate was 40.9%. Baseline CIV was significantly associated with 90-day mRS 0–2 (p=0.008) in the univariate analysis and was an independent predictor of 90-day mortality (adjusted OR 1.79, 95% CI 1.25 to 2.54, p=0.001). The ROC analysis showed that a CIV ≥4.7 mL at the initial MRI was the optimal cut-off to discriminate patients with a higher risk of death at 90 days (area under the ROC curve (AUC)=0.74, 95% CI 0.61 to 0.87, sensitivity and specificity of 87.9% and 58.1%, respectively).ConclusionsIn our series of MRI-selected patients with ABAO, pre-EVT CIV was an independent predictor of 90-day mortality. The risk of death was increased for baseline CIV ≥4.7 mL.

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Endovascular Treatment for Acute Basilar Artery Occlusion: A Single Center Retrospective Observational Study

10.21203/rs.2.10767/v1 ◽

2019 ◽

Author(s):

xuan sun ◽

xu tong ◽

feng gao ◽

huiting lao ◽

zhongrong miao

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Balloon Dilation ◽

High Volume ◽

Functional Independence ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Anterior Circulation ◽

Intracranial Atherosclerotic Disease

Abstract Background and purpose: Endovascular treatment (EVT) is now considered the gold standard for select patient populations with anterior circulation stroke; however, data on the treatment of posterior circulation stroke are less clear. This study aims to determine the characteristics and treatment outcomes of patients with acute basilar artery occlusion (BAO) and to evaluate the effectiveness and safety of EVT for patients with acute BAO in a high-volume stroke center. Methods: This study included 187 consecutive patients with acute BAO who underwent EVT from January 2012 to July 2018 in Beijing Tiantan Hospital. The baseline characteristics, procedure parameters, and functional outcome were assessed. Results: Among the 187 patients, 138 (73.8%) underwent mechanical thrombectomy with a stent retriever, 33 (17.6%) underwent direct intracranial angioplasty (balloon dilation and/or stent implantation) for underlying severe intracranial atherosclerotic disease, and 91 (48.7%) underwent combined mechanical thrombectomy and angioplasty. Successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3] was achieved in 158 patients (84.5%). Overall, the rates of functional independence [modified Rankin Scale (mRS) 0-2] and favorable outcome (mRS 0-3) at 90 days were 36.4% and 49.2%, respectively, and 90- day all-cause mortality was 20.3%. Conclusion􀀌􀀁EVT was effective and safe for treating patients with acute BAO.

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Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry: study protocol for a prospective, multicentre registry in China

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000188 ◽

2019 ◽

Vol 4 (1) ◽

pp. 57-60 ◽

Cited By ~ 4

Author(s):

Xiaochuan Huo ◽

Ning Ma ◽

Dapeng Mo ◽

Feng Gao ◽

Ming Yang ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Acute Ischaemic Stroke ◽

Treatment Algorithm ◽

Functional Independence ◽

Artery Occlusion ◽

Large Artery ◽

Vessel Occlusion ◽

Treatment Delivery ◽

Safety Endpoint

Background and purposeEndovascular treatment could improve functional outcomes and reduce mortality in patients with intracranial large artery occlusion. This registry aims to evaluate the endovascular treatment delivery and to improve endovascular treatment algorithm in clinical practice for patients with stroke in China.Methods and analysisThis multicentric, nationwide, prospective registry plans to include 20 stroke centres and recruit 900 consecutive AIS patients with large-artery occlusion under endovascular treatment. This registry will enrol acute large vessel occlusion patients suitable for endovascular treatment and the inclusion and exclusion criteria. In this study, 90 days functional independence (modified Rankin Scale score ≤2) is the primary efficacy endpoint. The procedural efficacy endpoint of this registry is target artery recanalisation defined by modified Thrombolysis in Cerebral Infarction score 2b or 3 after endovascular therapy. Symptomatic intracranial haemorrhage with 24±3 hours after the procedure is the primary safety endpoint of this registry.Ethics and disseminationBeijing Tiantan Hospital’s Ethics committee and all other participating centres approved the protocol and data collection of Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment registry. Each participant or representative had a written informed consent.

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