Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion

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.

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Blood pressure characteristics in patients with acute basilar artery occlusion undergoing endovascular thrombectomy

Scientific Reports ◽

10.1038/s41598-019-49769-8 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Slaven Pikija ◽

Katharina Millesi ◽

Monika Killer-Oberpfalzer ◽

J. Sebastian Mutzenbach ◽

Laszlo K. Sztriha ◽

...

Keyword(s):

Blood Pressure ◽

Basilar Artery ◽

Reference Value ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Good Outcome ◽

Frequent Use ◽

Life Threatening ◽

Lowering Drug ◽

The Individual

Abstract Acute basilar artery occlusion (BAO) is a rare but potentially life-threatening neurological condition. While endovascular therapy (EVT) has been shown to improve outcome, there is limited knowledge about prognostic factors beyond early recanalization. We studied whether blood pressure (BP) exceeds or falls below suggested thresholds during intervention and whether these changes are associated with complications and outcome. BP measurements mostly with one-minute intervals were available in 39 patients. An individual systolic blood pressure (SBP) reference value was defined as the median of the first five intra-procedural measurements. Half of the patients (51.3%) received drugs for BP augmentation and two a BP lowering drug (5.1%). Thrombolysis in cerebral infarction grade 2b and 3 (TICI) was achieved in 29 (74.4%) and 23 patients (58.9%) had good outcome at three months. We observed a continuous intra-procedural increase of median SBP (+11%) and mean arterial pressure (MAP, +10%, both p < 0.001), and a unique temporal pattern of intermittent peaks and troughs. Successful recanalization was more common in patients whose intra-procedural duration with SBP under 140 mmHg was shorter (p = 0.009). Patients with isolated tip of basilar artery (TBA) occlusion had significantly more BP excursion of 20% below the reference SBP and required more frequent use of sympathomimetic drugs compared to vertebrobasilar occlusion (p = 0.008 and p = 0.041, respectively). Brain hemorrhage was more prevalent in patients who experienced SBP excursions at least 20% above the individual reference value (p = 0.038) and a longer duration of time spent with SBP above 180 mmHg (p = 0.029). Patients with higher pre-procedural mean SBP had a greater chance of a good outcome (p = 0.03). This study using high resolution BP monitoring suggests a relationship between intra-procedural BP characteristics and recanalization, hemorrhagic complications and outcome in patients receiving EVT for acute posterior circulation cerebrovascular syndromes. Differences with regard to BP regulation during recanalization therapy for vertebrobasilar and TBA occlusion deserves further attention.

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Clot Meniscus Sign: An Angiographic Clue for Choosing between Stent Retriever and Contact Aspiration in Acute Basilar Artery Occlusion

American Journal of Neuroradiology ◽

10.3174/ajnr.a6988 ◽

2021 ◽

Author(s):

S.H. Baik ◽

C. Jung ◽

B.M. Kim ◽

K. Han ◽

D.J. Kim

Keyword(s):

Basilar Artery ◽

Artery Occlusion ◽

Stent Retriever ◽

Basilar Artery Occlusion

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Abstract TP11: Thromboaspiraiton vs Stent Retriever Thrombectomy for Basilar Artery Occlusion

Stroke ◽

10.1161/str.49.suppl_1.tp11 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Diogo C Haussen ◽

Alhamza Al-Bayati ◽

Jonathan Grossberg ◽

Clara Barreira ◽

Michael Frankel ◽

...

Keyword(s):

Basilar Artery ◽

Artery Occlusion ◽

Stent Retriever ◽

Basilar Artery Occlusion

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Rapid Successful Reperfusion of Basilar Artery Occlusion Strokes With Pretreatment Diffusion‐Weighted Imaging Posterior‐Circulation ASPECTS <8 Is Associated With Good Outcome

Journal of the American Heart Association ◽

10.1161/jaha.118.010962 ◽

2019 ◽

Vol 8 (10) ◽

Cited By ~ 7

Author(s):

Morgan Guillaume ◽

Bertrand Lapergue ◽

Benjamin Gory ◽

Julien Labreuche ◽

Arturo Consoli ◽

...

Keyword(s):

Basilar Artery ◽

Diffusion Weighted Imaging ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Good Outcome ◽

Diffusion Weighted

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Outcome Predictors in Acute Basilar Artery Occlusion

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

10.1017/s0317167100017327 ◽

2014 ◽

Vol 41 (3) ◽

pp. 368-374 ◽

Cited By ~ 3

Author(s):

Tomáš Dornák ◽

Roman Herzig ◽

David Školoudík ◽

Daniel Šanák ◽

Martin Kuliha ◽

...

Keyword(s):

Diabetes Mellitus ◽

Basilar Artery ◽

Neurological Deficit ◽

Binary Logistic Regression ◽

Treatment Method ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Binary Logistic Regression Analysis ◽

Severe Stroke ◽

Good Outcome

Objective:To identify predictors of good outcome in acute basilar artery occlusion (BAO).Background:Acute ischemic stroke (AIS) caused by BAO is often associated with a severe and persistent neurological deficit and a high mortality rate.Methods:The set consisted of 70 consecutive AIS patients (51 males; mean age 64.5±14.5 years) with BAO. The role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30- and 90-day outcome was assessed using the modified Rankin scale with a good outcome defined as a score of 0–3.Results:The following statistically significant differences were found between patients with good versus poor outcomes: mean age (54.2 vs. 68.9 years; p=0.0001), presence of arterial hypertension (52.4% vs. 83.7%; p=0.015), diabetes mellitus (9.5% vs. 55.1%; p=0.0004) and severe stroke (14.3% vs. 65.3%; p=0.0002), neurological deficit at time of treatment (14.0 vs. 24.0 median of National Institutes of Health Stroke Scale [NIHSS] points; p=0.001), successful recanalization (90.0% vs. 54.2%; p=0.005), change in neurological deficit (12.0 vs. 1.0 median difference of NIHSS points; p=0.005). Stepwise binary logistic regression analysis identified age (OR=0.932, 95% CI=0.882–0.984; p=0.012), presence of diabetes mellitus (OR=0.105, 95% CI=0.018–0.618; p=0.013) and severe stroke (OR=0.071, 95% CI=0.013–0.383; p=0.002) as significant independent negative predictors of good outcome.Conclusions:In the present study, higher age, presence of diabetes mellitus and severe stroke were identified as significant independent negative predictors of good outcome.

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Age and discharge modified Rankin score are associated with 90-Day functional outcome after basilar artery occlusion treated with endovascular therapy

Interventional Neuroradiology ◽

10.1177/1591019920987040 ◽

2021 ◽

pp. 159101992098704

Author(s):

Rahul R Karamchandani ◽

Dale Strong ◽

Jeremy B Rhoten ◽

Tanushree Prasad ◽

Jacob Selig ◽

...

Keyword(s):

Functional Outcome ◽

Basilar Artery ◽

Endovascular Therapy ◽

Univariate Analysis ◽

Prognostic Indicator ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Multivariable Logistic Regression Analysis ◽

Stroke Registry ◽

Good Outcome

Introduction Prognostic factors for functional outcome after basilar artery occlusion (BAO) treated with modern endovascular therapy (EVT) are sparse. We investigated the association between clinical characteristics, readily available imaging variables, and outcome in BAO patients treated with EVT. Methods Retrospective analysis from a large healthcare system’s prospectively collected code stroke registry of acute BAO patients treated with EVT between January 2017–January 2020. The primary outcome measure was a favorable 90-day modified Rankin score (mRS) of 0-2. Results 65 patients (median age 67 years, 57% male, median NIHSS 16) met the study inclusion criteria. Thrombolysis in Cerebral Infarction (TICI) 2 b-3 revascularization was achieved in 57/65 patients (88%) with a median time to revascularization of 445 minutes [IQR 302-840]. Ninety-day good outcome was seen in 35% (23/65) of patients. In a univariate analysis, age, history of ischemic stroke, baseline NIHSS, BAO site, and discharge mRS were associated with significant differences between the good and poor outcome groups. A multivariable logistic regression analysis demonstrated an independent association with 90-day good outcome and younger age (per 1-year, OR 0.79, 95% CI 0.64, 0.98) and good discharge mRS (0-2) (OR > 999.99, 95% CI 13.26, > 999.99). Conclusions Patients presenting with an acute BAO treated with modern EVT have a good 90-day outcome in over one-third of cases. Age and discharge mRS are independently associated with good 90-day outcome. Additional studies may focus on factors that can enhance discharge function after BAO, a novel prognostic indicator for favorable 90-day outcome in our study.

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