Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome

Background and purposeTo determine the initial factors, including patient characteristics, stroke etiology and severity, time factors, and imaging findings, that could affect the clinical outcome of patients with acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) where successful recanalization was achieved via mechanical thrombectomy.MethodsBetween March 2011 and December 2014, 35 patients with AIS caused by BAO received MRI/MR angiography-based mechanical thrombectomies, and recanalization was achieved with a Thrombolysis In Cerebral Infarction score of >2b. The patients were divided into a good outcome group (n=19), defined as those with a modified Rankin Scale (mRS) score of 0–2 at 3 months after stroke onset, and a poor outcome group (n=16), defined as a mRS score of 3–6. The differences between the groups were analyzed.ResultsInitial National Institutes of Health Stroke Scale (NIHSS) score (good vs poor: 17.9±8.9 vs 27.6±8.5, p=0.003), posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) based on initial diffusion-weighted images (DWI) (good vs poor: 7.8±1.6 vs 5.4±1.8, p=0.001), pc-ASPECTS based on contrast staining on the post-thrombectomy control CT (good vs poor: 9.2±1.5 vs 6.3±2.2, p<0.001), and presence of contrast staining in the brainstem on that CT (good vs poor: 15.8% vs 81.6%, p<0.001) were significantly different between the groups.ConclusionsPatients with AIS caused by BAO with a lower initial NIHSS score, fewer lesions on initial DWI, and less contrast staining on the post-thrombectomy control CT have higher probabilities of a good clinical outcome after successful recanalization via a mechanical thrombectomy.

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Mechanical Thrombectomy for Tandem Vertebrobasilar Stroke

Stroke ◽

10.1161/strokeaha.120.029503 ◽

2020 ◽

Vol 51 (6) ◽

pp. 1883-1885

Author(s):

Sung Hyun Baik ◽

Cheolkyu Jung ◽

Byung Moon Kim ◽

Dong Joon Kim

Keyword(s):

Clinical Outcome ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Access Route ◽

Procedure Time ◽

Good Clinical Outcome ◽

Vertebrobasilar Stroke

Background and Purpose— Tandem vertebrobasilar strokes are not well-known causes of posterior circulation stroke. The purpose of this study was to investigate the characteristics and outcome of mechanical thrombectomy in patients with tandem vertebrobasilar stroke. Methods— Acute basilar artery occlusion patients with tandem vertebral artery (VA) stenosis/occlusion who underwent mechanical thrombectomy were retrospectively analyzed. Concomitant tandem VA steno-occlusion was defined as severe stenosis/occlusion of the extracranial VA with impaired flow. Clinical/angiographic characteristics, recanalization rate, procedure time, and clinical outcome were evaluated with comparisons according to the treatment strategy. Results— Tandem vertebrobasilar occlusion was identified in 24.6% (55 of 224) of the acute basilar artery occlusion patients. Overall successful recanalization and good clinical outcome was achieved in 87.2% (48 of 55) and 30.9% (17 of 55) of the patients. There were no significant differences in procedure time, recanalization rate, and clinical outcome in comparisons of the VA access route selection or angioplasty of the tandem VA lesion. Two patients developed short-term recurrent basilar artery occlusion when angioplasty of the tandem VA lesion was not performed. Good clinical outcome was more likely with lower baseline National Institutes of Health Stroke Scale score (odds ratio, 0.87 [95% CI, 0.787–0.961]; P =0.006) and short onset-to-recanalization time (odds ratio, 0.993 [95% CI, 0.987–0.999]; P =0.03). Conclusions— Tandem vertebrobasilar occlusion may be a frequent pathological mechanism of posterior circulation stroke. Good outcome may be achieved by strategic choice of the access route and selective angioplasty of the tandem VA lesion.

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Mechanical thrombectomy in acute basilar artery occlusion: A safety and efficacy single centre study

Interventional Neuroradiology ◽

10.1177/1591019916631145 ◽

2016 ◽

Vol 22 (3) ◽

pp. 310-317 ◽

Cited By ~ 10

Author(s):

Mariano Werner ◽

Antonio Lopez-Rueda ◽

Federico Zarco ◽

Luis San Román ◽

Jordi Blasco ◽

...

Keyword(s):

Mortality Rate ◽

Tracheal Intubation ◽

Clinical Outcome ◽

Scale Score ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Level Of Consciousness

Objectives The objective of this study was to add more evidence about the efficacy and safety of mechanical thrombectomy in patients with basilar artery occlusion and secondarily to identify prognostic factors. Methods Twenty-two consecutive patients (mean age 60.5 years, 15 men) with basilar artery occlusion treated with mechanical thrombectomy were included. Clinical, procedure and radiological data were collected. Primary outcomes were the modified Rankin scale score with a good outcome defined by a modified Rankin scale score of 0–2 and mortality rate at three months. Results The median National Institutes of Health stroke scale at admission was 24 (interquartile range 11.5–31.25). Twelve patients (54.5%) required tracheal intubation due to a decreased level of consciousness. Successful recanalisation (modified treatment in cerebral ischaemia scale 2b–3) was achieved in 20 patients (90.9%). A favourable clinical outcome (modified Rankin scale score 0–2) was observed in nine patients (40.9%) and the overall mortality rate was 40.9% (nine patients). Haemorrhagic events were observed in three patients (13.63%). A decreased level of consciousness requiring intubation in the acute setting was more frequent in patients with poor outcomes (84.6%) than in patients with favourable outcomes (11.1%), and in patients who died (100%) compared with those who survived (23.1%), with a statistically significant difference ( P = 0.002 and P = 0.001, respectively). Conclusion Mechanical thrombectomy is feasible and effective in patients with acute basilar artery occlusion. A decreased level of consciousness requiring tracheal intubation seems to be a prognostic factor and is associated with a poor clinical outcome and higher mortality rate. These initial results must be confirmed by further prospective studies with a larger number of patients.

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Neuroimaging Predictors of Clinical Outcome in Acute Basilar Artery Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2017.00293 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 2

Author(s):

Ravi Garg ◽

José Biller

Keyword(s):

Clinical Outcome ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Basilar Artery Occlusion Chinese Endovascular Trial: Protocol for a prospective randomized controlled study

International Journal of Stroke ◽

10.1177/17474930211040923 ◽

2021 ◽

pp. 174749302110409

Author(s):

Chuanhui Li ◽

Chuanjie Wu ◽

Longfei Wu ◽

Wenbo Zhao ◽

Jian Chen ◽

...

Keyword(s):

Sample Size ◽

Basilar Artery ◽

Symptom Onset ◽

Primary Outcome ◽

Mechanical Thrombectomy ◽

Infarct Volume ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Controlled Study ◽

Randomized Controlled

Rationale There are no randomized trials examining the best treatment for acute basilar artery occlusion in the 6–24-hour time window. Aims To assess the safety and efficacy of thrombectomy for stroke due to basilar artery occlusion in patients randomized within 6–24 h from symptom onset or time last seen well. Sample size For an estimated difference of 20% in proportions of the primary outcome between the two groups, 318 patients will be included for 5% significance and 90% power with a planned interim analysis after two-thirds of the sample size (212 patients) have achieved the 90 days follow-up. Methods and design A prospective, multi-center, randomized, controlled, open-label and blinded-endpoint trial. The randomization employs a 1:1 ratio of mechanical thrombectomy with the detachable Solitaire thrombectomy device and best medical therapy (BMT) vs. BMT alone. Study outcomes The primary outcome will be the proportion of patients achieving modified Rankin Scale (mRS) 0–3 at 90 days. Key secondary outcomes are: dramatic early favorable response, dichotomized mRS score (0–2 vs. 3–6 and 0–4 vs. 5–6) at 90 days, ordinal (shift) mRS analysis at 90 days, infarct volume at 24 h, vessel recanalization at 24 h in both treatment arms, and successful recanalization in the thrombectomy arm according to the modified thrombolysis in cerebral infarction (mTICI) classification defined as mTICI 2 b or 3. Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage rates at 24 h, and procedure-related complications. Discussion Results from this trial will indicate whether mechanical thrombectomy is superior to medical management alone in achieving favorable outcomes in subjects with acute stroke caused by basilar artery occlusion presenting within 6–24 h from symptom onset. Trial registration: URL: http://www.clinicaltrials.gov . ClinicalTrials.gov Identifier: NCT02737189.

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Correction to: Mechanical Thrombectomy in Basilar Artery Occlusion

Clinical Neuroradiology ◽

10.1007/s00062-017-0661-1 ◽

2018 ◽

Vol 29 (1) ◽

pp. 161-162 ◽

Cited By ~ 1

Author(s):

Volker Maus ◽

Alev Kalkan ◽

Christoph Kabbasch ◽

Nuran Abdullayev ◽

Henning Stetefeld ◽

...

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Abstract 1122‐000147: Factors associated with the Delayed Door to Puncture Time for the Basilar Artery Occlusion patient

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000147 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Brandon Nguyen ◽

Ichiro Yuki ◽

Dana Stradling ◽

Jordan C Xu ◽

Kiarash Golshani ◽

...

Keyword(s):

Clinical Outcomes ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Medical Center ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

P Value ◽

Vessel Occlusion ◽

Factors Associated ◽

Delayed Initiation

Introduction : Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence‐based. In the real‐world practice, it is also often encountered that the delayed initiation of the MT happens for this particular patient groups due to lack of cortical signs and other medical confounding factors. Methods : We retrospectively analyzed the angiographical and clinical outcomes of consecutive BAO patient who underwent MT in single institution. Onset to treatment (OTT), Door to Puncture (DTP) time were compared with those in anterior circulation large vessel occlusion (ACLVO) group who underwent MT in the same time period. For those showed significantly longer DTP time, the factors associated with the delayed initiation of the MT were analyzed. Results : A total of 271 patients underwent mechanical thrombectomy at UCI Medical Center between Jan 2016 and June 2021. Of these, 32 patients diagnosed as BAO by CTA and underwent MT were included in the study. Successful recanalization was achieved in 28 cases (87.5%), and symptomatic ICH occurred in 3 cases (9.4%). Nine patients (28.1%) showed good clinical outcomes (mRS 0–3) at 3 months. The median Onset to Puncture Time (OTT) was 340 min. The median DTP time (145 min) was significantly longer as compared to the ACLVO patients (99 min) (p value = 0.04). Of the 6 patients who showed significant delay in the initiation of intervention (DTP>300 min), 5 patients (83.3%) did not have the initial “stroke‐code activation” at the time of ED arrival. The cause of the delay was due to lack of cortical sign (3), bilateral spontaneous sustained clonus, which misinterpreted as seizure (1), AMS with non‐focal neurological signs interpreted as encephalopathy (2). Conclusions : DTP of the patients who underwent MT for BAO was significantly longer than that in ACLAO. Lack of cortical sings which are markers of ACLVO were associated with delayed activation of stroke code. Establishment of BAO screening in the ED assessment and prompt activation of Stroke code may contribute to the improvement of MT treatment for the BAO patients.

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Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

10.22514/sv.2021.038 ◽

2021 ◽

Keyword(s):

General Anaesthesia ◽

Basilar Artery ◽

Endovascular Therapy ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Anterior Circulation ◽

Significant Difference ◽

Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

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Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽

10.1186/s12883-020-02013-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jin Wook Choi ◽

Miran Han ◽

Jung Hyun Park ◽

Woo Sang Jung

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Treatment Method ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Procedure Time ◽

First Line ◽

Aspiration Thrombectomy ◽

First Pass ◽

First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

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