Basilar artery thrombectomy: assessment of outcome and identification of prognostic factors

Trần, Anh Tuấn; Nguyen, Huu An; Vu, Dang Luu; Pham, Minh Thong; Tran, Cuong; Le, Hoang Kien; Nguyen, Quang; Nguyen, Thu Trang; Nguyen, Tat Thien; Show, Pau Loke; Czarzasta, Joanna; Chu-Dinh, Thien; Tao, Yang; Chu, Dinh‐Toi

doi:10.1007/s13760-019-01223-2

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…The aim of the present study was to analyze the outcome of MT in patients with acute ischemic PCS in one institution over the period of four years and to evaluate the clinical and procedural factors associated with recanalization, outcome, and mortality. Successful recanalization, defined as mTICI 2b–3, was observed in 38/43 (88.4%) patients, which is within the range of successful recanalization achieved in other studies (10–15). Favorable clinical outcome was observed in 26/43 (60.5%) patients and 11 patients died, resulting in a final mortality rate of 25.6%.…”

Section: Discussionsupporting

confidence: 81%

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Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors

et al. 2020

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Background Mechanical thrombectomy (MT) is well-established in the treatment of acute ischemic anterior circulation stroke. However, there is no evidence from randomized trials or meta-analyses that MT is safe and effective in the treatment of patients with acute ischemic posterior circulation stroke (PCS). Purpose To evaluate the clinical and procedural factors associated with recanalization and outcome of patients with PCS treated with MT. Material and Methods Forty-three patients with PCS (median age 73 years) who underwent treatment with MT were included. Data including demographics, baseline stroke severity, radiological imaging, procedure and post-procedure complications were documented. Clinical outcome was evaluated using the modified Rankin Scale (mRS). The patients were classified into two groups based on clinical outcome (favorable vs. unfavorable mRS after 90 days). Results Median baseline National Institute of Health Stroke Scale (NIHSS) was 17. Twenty patients were eligible for intravenous thrombolysis and received recombinant tissue plasminogen activator before MT. Successful recanalization was observed in 88.4% of patients. After 90 days, favorable outcome (defined as mRS 0–2) was achieved in 26 patients; six patients had an unfavorable outcome (mRs >2). Final mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, procedure duration, and successful recanalization had a statistically significant association with outcome. Failed recanalization and occurrence of intracranial hemorrhage were found to be associated with a higher mortality rate. Conclusion MT is feasible and effective method in treatment of PCS. Baseline NIHSS and onset to reperfusion time were found to be independent predictive factors of clinical outcome.

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Section: Discussionsupporting

confidence: 81%

“…Comparison of patients who survived with those who died also presented significant difference in rates of successful recanalization (64% in those who died compared to 97% in those who survived, P = 0.003). Previous studies showed that successful recanalization of basilar artery was related to a twofold reduction in mortality (15,18).…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors

et al. 2020

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“…In our series, the rate of favorable outcome was slightly lower (31.8%) compared with other reports (42%-54%), 4,17,19,[25][26][27][28] with higher rates of mortality (40.9% versus 12%-35%) 4,19,[25][26][27][28][29] and poor outcome (mRS 3-5, 27%). These results suggest that among patients with posterior circulation ischemic stroke, if reperfusion appears to be an important factor in functional independence, other variables potentially influence the final neurologic status.…”

Section: Clinical Predictors Of Outcomecontrasting

confidence: 79%

Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion

Mahmoudi¹,

Dargazanli²,

Derraz³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Clinical outcomes after endovascular treatment for acute basilar artery occlusions need further investigation. Our aim was to analyze predictors of a 90-day good functional outcome defined as mRS 0-2 after endovascular treatment in MR imaging-selected patients with acute basilar artery occlusions. MATERIALS AND METHODS:We analyzed consecutive MR imaging-selected patients with acute basilar artery occlusions endovascularly treated within the first 24 hours after symptom onset. Successful and complete reperfusion was defined as modified TICI scores 2b-3 and 3, respectively. Outcome at 90 days was analyzed in univariate and multivariate analysis regarding baseline patient treatment characteristics and periprocedural outcomes. RESULTS:One hundred ten patients were included. In 10 patients, endovascular treatment was aborted for failed proximal/distal access. Overall, successful reperfusion was achieved in 81.8% of cases (n ¼ 90; 95% CI, 73.3%-88.6%). At 90 days, favorable outcome was 31.8%, with a mortality rate of 40.9%; the prevalence of symptomatic intracranial hemorrhage within 24 hours was 2.7%. The median time from symptom onset to groin puncture was 410 minutes (interquartile range, 280-540 minutes). In multivariable analysis, complete reperfusion (OR ¼ 6.59; 95% CI , 2.17-20.03), lower pretreatment NIHSS (OR ¼ 0.77; 95% CI , 0.64-0.94), the presence of posterior communicating artery collateral flow (OR ¼ 2.87; 95% CI, 1.05-7.84), the absence of atrial fibrillation (OR ¼ 0.18; 95% CI , 0.03-0.99), and intravenous thrombolysis administration (OR ¼ 2.75; 95% CI, 1.04-7.04) were associated with 90-day favorable outcome. CONCLUSIONS:In our series of MR imaging-selected patients with acute basilar artery occlusions, complete reperfusion was the strongest predictor of a good outcome. Lower pretreatment NIHSS, the presence of posterior communicating artery collateral flow, the absence of atrial fibrillation, and intravenous thrombolysis administration were associated with favorable outcome. ABBREVIATIONS: ABAO ¼ acute basilar artery occlusion; BSS ¼ brain stem score; EVT ¼ endovascular treatment; GCS ¼ Glasgow Coma Scale; IQR ¼ interquartile range; IVT ¼ intravenous thrombolysis; mTICI ¼ modified TICI; PC-ASPECTS ¼ posterior circulation ASPECTS; PcomA ¼ posterior communicating artery; sICH ¼ =symptomatic intracranial hemorrhage

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“…Until 1994, Kitano firstly described the efficacy of laparoscopy gastrectomy (LG) in the case of early stage carcinoma in the antrum of the stomach [6]. Then, the employment of LG for gastric cancer has achieved rapid development and popularities in past decades due to minimal invasion, less blood loss, less time of using analgesic requirement and quicker recovery [7][8][9][10]. Another benefit of laparoscopic surgery is the capacity to observe the surgical field in a magnified view, which could help surgeons with more meticulous dissection of lymph nodes which is important to patient's prognosis [11].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open gastrectomy for gastric cancer

et al. 2020

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Background:Compared with open gastrectomy (OG), laparoscopic gastrectomy (LG) for gastric cancer has achieved rapid development and popularities in the past decades. However, lack of comprehensive analysis in longterm oncological outcomes such as recurrence and mortality hinder its full support as a valid procedure. Therefore, there are still debates on whether one of these options is superior. Aim: To evaluate the primary and secondary outcomes of laparoscopic versus open gastrectomy for gastric cancer patients Methods: Two authors independently extracted study data. Risk ratio (RR) with 95% confidence interval (CI) was calculated for binary outcomes, mean difference (MD) or the standardized mean difference (SMD) with 95% CI for continuous outcomes, and the hazard ratio (HR) for time-to-event outcomes. Review Manager 5.3 and STATA software were used for the meta-analysis.Results: Seventeen randomized controlled trials (RCTs) involving 5204 participants were included in this metaanalysis. There were no differences in the primary outcomes including the number of lymph nodes harvested during operation, severe complications, short-term and long-term recurrence, and mortality. As for secondary outcomes, compared with the OG group, longer operative time was required for patients in the LG group (MD = 58.80 min, 95% CI = [45.80, 71.81], P < 0.001), but there were less intraoperative blood loss (MD = − 54.93 ml, 95% CI = [− 81.60, − 28.26], P < 0.001), less analgesic administration (frequency: MD = − 1.73, 95% CI = [− 2.21, − 1.24], P < 0.001; duration: MD = − 1.26 days, 95% CI = [− 1.40, − 1.12], P < 0.001), shorter hospital stay (MD = − 1.37 days, 95% CI = [− 2.05, − 0.70], P < 0.001), shorter time to first flatus (MD = − 0.58 days, 95% CI = [− 0.79, − 0.37], P < 0.001), ambulation (MD = − 0.50 days, 95% CI = [− 0.90, − 0.09], P = 0.02) and oral intake (MD = − 0.64 days, 95% CI = [− 1.24, − 0.03], P < 0.04), and less total complications (RR = 0.81, 95% CI = [0.71, 0.93], P = 0.003) in the OG group. There was no difference in blood transfusions (number, quantity) between these two groups. Subgroup analysis, sensitivity analysis, and the adjustment of Duval's trim and fill methods for publication bias did not change the conclusions. Conclusion:LG was comparable to OG in the primary outcomes and had some advantages in secondary outcomes for gastric cancer patients.LG is superior to OG for gastric cancer patients.

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Basilar artery thrombectomy: assessment of outcome and identification of prognostic factors

Cited by 11 publications

References 22 publications

Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors

Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors

Predictors of Favorable Outcome after Endovascular Thrombectomy in MRI: Selected Patients with Acute Basilar Artery Occlusion

Laparoscopic versus open gastrectomy for gastric cancer

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