Plasma Homocysteine and Prognosis of Patients with Recanalization after Acute Basilar Artery Occlusion: An Analysis from the Acute Basilar Artery Occlusion Study (BASILAR) Nationwide Prospective Registry

Background: Few studies have investigated the association between plasma homocysteine (Hcy) levels in patients with recanalization after acute basilar artery occlusion (BAO). Objective: This study investigated the predictive value of Hcy on the clinical prognosis of patients with recanalization after acute BAO. Methods: Altogether, 829 participants were recruited from the standard medical treatment plus endovascular treatment group of the Acute Basilar Artery Occlusion Study (BASILAR). Hcy levels were measured the morning after admission. The primary outcome was a combination of death and major disability (modified Rankin Scale score 4-6) at 90 days, and the secondary outcome was the mortality of patients with recanalization after acute BAO within 90 days. We used multivariable logistic regression modeling to estimate the association between Hcy and prognosis in our participants at 90 days. Results: Altogether, 647 patients were assessed, and 302 patients were included in this study. The median was 12.88 μmol/L, and the mean Hcy concentration was 15.49 μmol/L. Elevated plasma Hcy levels (Hcy >12.88 μmol/L) were associated with poor functional outcomes (adjusted odds ratio 1.922, 95% confidence interval [CI] 1.048-3.528], P=0.035), but not with mortality (adjusted odds ratio 1.605, 95% CI 0.986-2.489, P=0.058). In further subgroup analysis, the conclusion was consistent in all predefined subgroups. Conclusion: Our analysis suggests that elevated plasma Hcy levels have predictive value for functional outcomes in patients with recanalization after acute BAO during the 90-day follow-up period, but not for mortality.

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Safety and Efficacy of Endovascular Treatment for Progressive Stroke in Patients With Acute Basilar Artery Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2021.774443 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yinxu Wang ◽

Yingbing Ke ◽

Lingling Wang ◽

Qing Wu ◽

Jing Zhou ◽

...

Keyword(s):

Confidence Interval ◽

Basilar Artery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Treatment Time ◽

Time Window ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Standard Medical Therapy ◽

Desirable Outcome

Background and Purpose: It is unknown the benefit of endovascular therapy (EVT) for progressive stroke in patients with basilar artery occlusion (BAO). The aim of this study was to compare the efficacy and safety of EVT with standard medical therapy (SMT) in a population of BAO patients with progressive stroke.Methods: The EVT for Acute Basilar Artery Occlusion Study (BASILAR) is a national prospective registry of consecutive patients with acute BAO within 24 h of symptom onset. According to the applied therapy, all patients were divided into SMT and EVT groups. Subsequently, the EVT group was divided into early (≤6 h) and late groups (>6 h) according to the time window. The efficacy outcome was favorable functional outcomes (modified Rankin Scale score ≤ 3) at 90 days. The safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage (sICH) after EVT.Results: The EVT cohort presented more frequently with a favorable functional outcome (adjusted odds ratio, 5.49; 95% confidence interval, 2.06–14.61, p = 0.01) and with a decreased mortality (adjusted odds ratio, 0.3; 95% confidence interval, 0.17–0.54, p < 0.001). What's more, EVT still safe (P = 0.584, P = 0.492, respectively) and effective (P = 0.05) in patients with progressive stroke when the treatment time window exceeds 6 h.Conclusions: EVT was more effective and safer than SMT for progressive stroke in patients with BAO. Besides, EVT remains safe and effective in patients with progressive stroke when the treatment time window exceeds 6 h. Predictors of desirable outcome in progressive stroke patients undergoing EVT included lower baseline NIHSS score, higher baseline pc-ASPECTs, successful recanalization and shorter puncture to recanalization time.

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Predictive value on diffusion weighted imaging scores for basilar artery occlusion after endovascular treatment

Interventional Neuroradiology ◽

10.1177/1591019920940514 ◽

2020 ◽

pp. 159101992094051

Author(s):

Can Wan ◽

Guangliang Wu ◽

Xing Jin ◽

Shaojun Liao ◽

Foming Zhang ◽

...

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Predictive Value ◽

Odds Ratio ◽

Diffusion Weighted Imaging ◽

Area Under The Curve ◽

Artery Occlusion ◽

Favorable Outcome ◽

Basilar Artery Occlusion ◽

Diffusion Weighted

Purpose To assess the predictive value of three scoring systems based on diffusion weighted imaging in basilar artery occlusion patients after endovascular treatment. Methods We analyzed clinical and radiological data of patients with basilar artery occlusion from January 2010 to June 2019, with modified Rankin Scale of 0–2 and 3–6 defined as favorable outcome and unfavorable outcome at three months. Diffusion weighted imaging posterior circulation ASPECTS Score (DWI pc-ASPECT Score), Renard diffusion weighted imaging Score, and diffusion weighted imaging Brainstem Score were used to evaluate the early ischemic changes. Results There were a total of 88 basilar artery occlusion patients enrolled in the study after endovascular treatment, with 33 of them getting a favorable outcome. According to the analysis, the time from onset to puncture within 12 h (odds ratio: 4.34; 95% confidence interval: 1.55–12.16; P = 0.01), presence of collateral flow via PCoA (odds ratio: 0.31; 95%CI: 0.12–0.79; P = 0.01) or between PICA and SCA (odds ratio: 0.18; 95%CI: 0.07–0.47; P = 0.00), equal or less than 15 points on baseline NIHSS (area under the curve 0.79, 95% CI 0.69–0.89; sensitivity = 69.1%, specificity = 81.8%; P = 0.00), and equal or less than 1.5 points on diffusion weighted imaging Renard score (area under the curve 0.63, 95% CI 0.51–0.75; sensitivity = 83.6%, specificity = 39.4%; P = 0.046) were independently associated with favorable outcome. Conclusions Renard diffusion weighted imaging score may be an independent predictor of functional outcome in basilar artery occlusion patients after endovascular treatment.

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Endovascular intervention for basilar artery occlusion in the elderly

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211000453 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110004

Author(s):

Weidong Luo ◽

Wenguo Huang ◽

Min Zhang ◽

Xing Liu ◽

Zhangbao Guo ◽

...

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Basilar Artery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Nihss Score ◽

Symptomatic Intracranial Hemorrhage ◽

Favorable Functional Outcome

Background: To date, few data have been reported on clinical outcomes following interventions in elderly populations with acute basilar artery occlusion. Using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR), we evaluated the efficacy and safety of intervention and determined predictors of outcomes among elderly patients in China. Methods: Patients from January 2014 to May 2019 were dichotomized into elderly (75 years or older) and nonelderly patients (under 75 years). Pearson’s Chi-square test and multivariate logistic regression were performed to assess 90-day favorable functional outcome (defined as a modified Rankin scale score of 0–3), mortality and symptomatic intracranial hemorrhage between intervention and conservative cohorts in elderly patients. Results: Among the 829 patients in the BASILAR, 182 patients aged 75 years or older were analyzed. These patients were divided into intervention (127 patients) and conservative (55 patients) cohorts. Compared with the conservative cohort, the intervention cohort presented more frequently with a favorable functional outcome (28.3% versus 12.7%; p = 0.023) and with a decreased mortality (54.3% versus 76.4%; p = 0.005). There was no difference in symptomatic intracranial hemorrhage (4.7% versus 0, p = 0.235). Multivariate analysis indicated that intervention was associated with favorable functional outcome (adjusted odds ratio, 0.262; 95% confidence interval, 0.088–0.778, p = 0.016) and lower mortality (adjusted odds ratio, 0.257; 95% confidence interval, 0.109–0.606, p = 0.002). In the intervention cohort, initial National Institutes of Health Stroke Scale (NIHSS) score and occlusion site were associated with functional outcome, and initial NIHSS score and recanalization were associated with mortality. Conclusions: Although the overall outcome following intervention was worse with age, intervention was more effective and safer than conservative treatment for elderly Chinese patients with basilar artery occlusion. Predictors of desirable outcome in elderly patients undergoing intervention included lower initial NIHSS score, occlusion site and successful recanalization. Clinical Trial Registration-URL: http://www.chictr.org . Unique identifier: ChiCTR-1800014759

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

Stroke ◽

10.1161/strokeaha.120.033658 ◽

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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Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014516 ◽

2019 ◽

Vol 11 (12) ◽

pp. 1174-1180 ◽

Cited By ~ 18

Author(s):

Thomas Raphael Meinel ◽

Johannes Kaesmacher ◽

Panagiotis Chaloulos-Iakovidis ◽

Leonidas Panos ◽

Pasquale Mordasini ◽

...

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Favorable Outcome ◽

Basilar Artery Occlusion ◽

Secondary Outcome ◽

Stroke Severity ◽

Anterior Circulation ◽

Link Type ◽

Significant Difference

BackgroundPerforming mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.ObjectiveTo compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.MethodsIn the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.ResultsMT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.ConclusionsIn selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.Trial registration numberNCT03496064

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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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Basilar Artery Occlusion Treated with Mechanical Thrombectomy beyond Eight Hours with Successful Recanalization and Good Functional Outcomes

Cerebrovascular Diseases ◽

10.1159/000218072 ◽

2009 ◽

Vol 27 (6) ◽

pp. 614-615 ◽

Cited By ~ 9

Author(s):

Mazen Noufal ◽

James W. Schmidley ◽

Eren Erdem ◽

Salah G. Keyrouz

Keyword(s):

Basilar Artery ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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

Stroke and Vascular Neurology ◽

10.1136/svn-2021-001242 ◽

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.

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Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions

Stroke ◽

10.1161/strokeaha.118.022466 ◽

2019 ◽

Vol 50 (2) ◽

pp. 389-395 ◽

Cited By ~ 9

Author(s):

Tobias Boeckh-Behrens ◽

David Pree ◽

Nina Lummel ◽

Benjamin Friedrich ◽

Christian Maegerlein ◽

...

Keyword(s):

Vertebral Artery ◽

Scale Score ◽

Basilar Artery ◽

Odds Ratio ◽

Artery Occlusion ◽

Low Flow ◽

Basilar Artery Occlusion ◽

Modified Rankin Scale ◽

Flow Conditions ◽

Vertebral Arteries

Background and Purpose— Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy. Methods— Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients’ characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3. Results— One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10–22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97–17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42–179.00). Conclusions— Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries.

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