Abstract TP82: High Rate of Recanalization and Attenuated Poor Outcome After Intravenous Thrombolysis in “Top-of-the-basilar” Syndrome

Objective: The safety and efficacy of intravenous thrombolysis (IVT) in patients with “top-of-the-basilar” syndrome (TOBS) was not systematically investigated. We thus aim to evaluate the rate of recanalization, hemorrhagic transformation and long-term prognosis after IVT in TOBS in our consecutively collected thrombolytic patients. Methods: We retrospectively examined clinical and imaging data from consecutive acute ischemic stroke patients with basilar artery occlusion (BAO) who underwent multimodal CT or MRI before and 24 hours after IVT at our center. The presence of Hyperdense artery sign (HAS) on noncontrast CT or Susceptibility vessel sign (SVS) on susceptibility-weighted imaging were recorded. Recanalization, hemorrhagic transformation (HT), and clinical outcome were assessed by Arterial Occlusive Lesion (AOL) scale, ECASS II definition and modified Rankin Scale (mRS), respectively. Results: Among all 43 BAO patients with pre- and post-treatment angiongraphy, 24 (55.8%) were considered as TOBS based on either CTA (n = 18) or TOF-MRA (n = 6) before IVT. Follow-up imaging revealed recanalization (AOL ≥ 2) in 19 (79.2%) and HT in 6 (25%) of TOBS patients. This recanalization rate of TOBS was much higher than other LAO (56.2% for M1, 68.0% for M2, 12.8% for internal carotid artery, 50.0% for anterior cerebral artery, 58.3% for posterior cerebral artery, and 21.1% for other type of BAO). Cardioembolic stroke were considered in 18 (75%) of TOBS. The presence of HAS or SVS in TOBS with recanalization was higher than those without (89.5% verse 40%, p=0.042). The rate of poor clinical outcome (mRS ≥ 3) was lower in patients with recanalization than those without recanalization (36.8% verse 100%, p=0.037). 3-month mortality were also lower in patients with recanalization (15.8% verse 80.0%, p=0.014). Conclusions: Most (about 80%) of TOBS patients can achieve recanalization after IVT, leading to a dramatic recovery in Chinese population. The presence of HAS or SVS of basilar artery might indicate high rate of recanalization.

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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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Abstract TMP13: Tenecteplase versus Alteplase Before Endovascular Therapy in Basilar Artery Occlusion

Stroke ◽

10.1161/str.51.suppl_1.tmp13 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Fana Alemseged ◽

Volker Puetz ◽

Gregoire Boulouis ◽

Alessandro Rocco ◽

Timothy Kleinig ◽

...

Keyword(s):

Basilar Artery ◽

Endovascular Therapy ◽

Primary Outcome ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Randomized Controlled ◽

Repeat Imaging

Background: Tenecteplase (TNK) is a genetically modified variant of alteplase with greater fibrin specificity and longer half-life than alteplase. The recent Tenecteplase versus Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK) trial demonstrated that increased reperfusion with TNK compared to alteplase prior to endovascular thrombectomy (EVT) in large vessel occlusion ischaemic strokes. However, only 6 patients with basilar artery occlusion (BAO) were included. We aimed to investigate the efficacy of TNK versus alteplase before EVT in patients with basilar artery occlusion (BAO). Methods: Clinical and procedural data of consecutive BAO diagnosed on CT Angiography or MR Angiography from the multisite international Basilar Artery Treatment and MANagement (BATMAN) collaboration were retrospectively analysed. The primary outcome was reperfusion of greater than 50% of the involved ischemic territory or absence of retrievable thrombus at the time of the initial angiographic assessment. Results: We included 119 BAO patients treated with intravenous thrombolysis prior to EVT; mean age 68 (SD 14), median NIHSS 16 (IQR 7-32). Eleven patients were treated with TNK (0.25mg/kg or 0.4mg/kg) and 108 with alteplase (0.9mg/kg). Overall, 113 patients had catheter angiography or early repeat imaging after thrombolysis. Reperfusion of greater than 50% of the ischemic territory or absence of retrievable thrombus occurred in 4/11 (36%) of patients treated with TNK vs 8/102 (8%) treated with alteplase (p=0.02). Onset-to-needle time did not differ between the two groups (p=0.4). Needle-to-groin-puncture time was 61 (IQR 33-100) mins in patients reperfused with TNK vs 111 (IQR 86-198) mins in patients reperfused with alteplase (p=0.048). Overall, the rate of symptomatic haemorrhage was 3/119 (2.5%). No differences were found in the rate of symptomatic intracranial haemorrhage (p=0.3) between the two thrombolytic agents. Conclusions: Despite shorter needle-to-groin-puncture times, tenecteplase was associated with an increased rate of reperfusion in comparison with alteplase before EVT in BAO. Randomized controlled trials to compare tenecteplase with alteplase in BAO patients before endovascular thrombectomy are warranted.

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Massive pontine hemorrhagic transformation associated with an anticoagulant for basilar artery occlusion

Neurology India ◽

10.4103/0028-3886.28123 ◽

2006 ◽

Vol 54 (4) ◽

pp. 431 ◽

Cited By ~ 5

Author(s):

Jiann-Der Lee ◽

Meng Lee ◽

Hsu-Huei Weng ◽

Ming-Chang Hsiao

Keyword(s):

Basilar Artery ◽

Hemorrhagic Transformation ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.51 ◽

2020 ◽

Vol 47 (4) ◽

pp. 479-485

Author(s):

Christopher R. Pasarikovski ◽

Houman Khosravani ◽

Leodante da Costa ◽

Chinthaka Heyn ◽

Stefano M. Priola ◽

...

Keyword(s):

Computed Tomography ◽

Functional Outcome ◽

Basilar Artery ◽

Treatment Time ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Related Complication ◽

Endovascular Thrombectomy

ABSTRACT:Background and Purpose:Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices.Methods:All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS.Results:A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270–639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome.Conclusion:EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.

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Erratum. Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever)

Journal of Neurosurgery ◽

10.3171/2017.7.jns171043a ◽

2018 ◽

Vol 129 (6) ◽

pp. 1649 ◽

Cited By ~ 6

Author(s):

Benjamin Gory ◽

Bertrand Lapergue

Keyword(s):

Clinical Outcome ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Stent Retriever ◽

Basilar Artery Occlusion ◽

First Line

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Timing of Recanalization After Microbubble-Enhanced Intravenous Thrombolysis in Basilar Artery Occlusion

Stroke ◽

10.1161/strokeaha.107.487454 ◽

2007 ◽

Vol 38 (11) ◽

pp. 2931-2934 ◽

Cited By ~ 22

Author(s):

Jorge Pagola ◽

Marc Ribo ◽

José Alvarez-Sabín ◽

Marcos Lange ◽

Marta Rubiera ◽

...

Keyword(s):

Basilar Artery ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Initial factors affecting the clinical outcome after successful recanalization via MR-based mechanical thrombectomy in patients with acute ischemic stroke due to basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011912 ◽

2015 ◽

Vol 8 (9) ◽

pp. 889-893 ◽

Cited By ~ 7

Author(s):

Seungnam Son ◽

Yong-Won Kim ◽

Min Kyun Oh ◽

Soo-Kyoung Kim ◽

Ki-Jong Park ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Nihss Score ◽

Diffusion Weighted Images ◽

Outcome Group

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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