Acute Basilar Artery Occlusion: Outcome of Mechanical Thrombectomy with Solitaire Stent within 8 Hours of Stroke Onset

Baek, Jonggyu; Yoon, Woong; Kim, S.K.; Jung, Min Young; Park, M.S.; Kim, J.T.; Kang, Heoung Keun

doi:10.3174/ajnr.a3813

Cited by 60 publications

(51 citation statements)

References 23 publications

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“…Overall, a good outcome was achieved On the pretreatment DWI, the median pc-ASPECTS was 7 (interquartile range, 6-8; range, [3][4][5][6][7][8][9]. None of the patients with a pc-ASPECTS of 3 to 5 (n=7) displayed a good outcome at 3 months; in contrast, all patients (n=6) with a pc-ASPECTS of 9 displayed a good outcome (Figure).…”

Section: Resultsmentioning

confidence: 95%

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

Yoon

Kim

Heo

et al. 2015

Stroke

101

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Background and Purpose— Factors related to prognosis after a modern mechanical thrombectomy in patients with acute basilar artery occlusion remain unclear. This study investigated the prognostic factors for patients with acute basilar artery occlusion who underwent a stent-retriever thrombectomy. Methods— We analyzed clinical and pretreatment diffusion-weighted imaging (DWI) data in 50 consecutive patients with acute basilar artery occlusion treated with stent-retriever thrombectomy. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and DWI parameters and functional outcome was evaluated with logistic regression analysis. Results— In a univariate analysis, the following variables were significantly associated with outcome: age, hypertension, baseline National Institutes of Health Stroke Scale, posterior circulation Acute Stroke Prognosis Early CT Score on a pretreatment DWI, posterior circulation Acute Stroke Prognosis Early CT Score of ≥7 (versus <7), thalamic infarction, and bilateral thalamic infarction. In a multivariate model, only a low initial National Institutes of Health Stroke Scale score (odds ratio, 0.82; 95% confidence interval, 0.709–0.949; P =0.008) and high DWI posterior circulation Acute Stroke Prognosis Early CT Score (odds ratio, 1.854; 95% confidence interval 1.012–3.397; P =0.045) were significant independent predictors of good outcome. In a univariate analysis, bilateral thalamic infarction was associated with a poor outcome (odds ratio, 1.993; 95% confidence interval, 1.187–3.346; P =0.035) but not with a unilateral thalamic infarction ( P =0.525). Conclusions— This study suggested that initial infarction severity and posterior circulation Acute Stroke Prognosis Early CT Score on a pretreatment DWI are independent predictors of clinical outcome after stent-retriever thrombectomy in patients with acute basilar artery occlusion.

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Section: Resultsmentioning

confidence: 95%

“…Details on techniques used for mechanical thrombectomy were previously described. 7 Intracranial angioplasty with or without stenting was performed when severe (>70%) underlying intracranial atherosclerotic stenosis was observed.…”

mentioning

confidence: 99%

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

Yoon

Kim

Heo

et al. 2015

Stroke

101

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“…35 Single-centre studies with samples less than 100 patients have shown good functional outcomes following thrombectomy of the basilar artery, ranging from 30% 36,37 to 48%. [38][39][40] Experience at the Karolinska Hospital showed a 57% rate of good functional outcome (95% CI 37% to 75%), and of 73% (95% CI 50% to 89%) when there were no signs of acute infarction prior to treatment, with about 21% mortality. 41 Recanalization rates over 75% were reported with new generation devices 37,42 as well as with older generation devices in the MERCI and multi-MERCI trials but with lower benefit.…”

Section: Aspects To Be Considered In Mechanical Thrombectomymentioning

confidence: 99%

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

Wahlgren

Moreira

Michel³

et al. 2015

International Journal of Stroke

323

224

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The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after

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“…Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke,4 the effectiveness and safety of modern thrombectomy remains uncertain for patients with acute BAO. Although multiple case studies have described endovascular therapy for acute BAO, previous studies are limited by small sample sizes, heterogeneous patient populations, and the use of older generation devices and techniques 3, 5, 6, 7, 8, 9. Moreover, several important issues remain to be elucidated, such as identifying predictors of functional outcome after modern thrombectomy or the selection of a first‐line thrombectomy technique for patients with acute BAO.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

115

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BackgroundDespite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.Methods and ResultsThis study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique.ConclusionsEndovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO.

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Acute Basilar Artery Occlusion: Outcome of Mechanical Thrombectomy with Solitaire Stent within 8 Hours of Stroke Onset

Cited by 60 publications

References 23 publications

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

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

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

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