Aspiration Versus Stent Retriever Thrombectomy in Basilar‐Artery Occlusion; Results From the BASICS Trial

Abstract

BACKGROUND Both aspiration and stent retriever thrombectomy are safe and effective in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation. Little is known on the outcomes of these techniques in patients with basilar artery occlusion. This study aimed to compare clinical, technical, and safety outcomes of aspiration and stent retriever thrombectomy as first‐line treatment for basilar artery occlusion in the BASICS (Basilar artery International Cooperation Study) trial. METHODS For this post hoc analysis of the BASICS trial, all patients with a basilar artery occlusion who received endovascular treatment with either direct aspiration or stent retriever thrombectomy as first‐line approach were included. When both techniques were registered as first choice, patients were considered to have been treated with stent retriever. The primary outcome was favorable functional outcome, defined as a modified Rankin scale score of 0–3 at 90 days follow‐up, and analyzed using binary logistic regression analysis. Secondary outcomes included the modified Rankin scale score at 90 days (ranging from 0 to 6), procedure duration, mortality at 90 days, and symptomatic intracranial hemorrhage. Secondary outcomes were analyzed using binary, linear, or ordinal regression analyses. All analyses were adjusted for predefined variables. RESULTS Among 158 BASICS patients treated with endovascular treatment,127 were treated with either stent retriever (N=67, 53%), or aspiration (N=60, 47%) as the first‐line treatment modality. We observed no significant difference in favorable functional outcome between patients treated with aspiration and stent retriever thrombectomy as first modality (adjusted odds ratio, 1.80; [95% CI, 0.68–4.76]). Also modified Rankin scale score at 90 days (adjusted common odds ratio, 0.62; [95% CI, 0.30–1.27]) and incidence of symptomatic intracranial hemorrhage (adjusted odds ratio, 0.61; [95% CI, 0.08–4.76]) showed no significant differences between both techniques. Procedure time was shorter with a median of 32 versus 47 minutes (26%; 95% CI, −42 to −6) and mortality rates at 90 days were lower (adjusted odds ratio, 0.36; [95% CI: 0.13–1.00]) in the direct aspiration group. CONCLUSIONS This study shows no difference in favorable functional outcome in patients with a basilar artery occlusion treated with direct aspiration compared with patients treated with stent retriever thrombectomy within the BASICS trial, despite a shorter procedure time and lower mortality rate at 90 days.

European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion

“…The literature search did not identify any completed RCTs comparing the different first-line treatment techniques in patients with BAO. For the comparison of the first-line contact aspiration and stent-retriever thrombectomy, the literature search identified one post-hoc analysis of an RCT 53 , seven registry-based observational studies [54][55][56][57][58][59][60] , and four single-centre retrospective observational studies [61][62][63][64] .…”

“…In the post-hoc analysis of the BASICS trial by Knapen et al 53 , 127 patients with BAO who underwent EVT with either direct aspiration (n=60) or stent retriever thrombectomy (n=67) as the first-line approach were included. The primary outcome was mRS score of 0-3 at 3 months.…”