Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy

Lee, Seong-Joon; Hong, Ji Man; Kim, Jong Seung; Lee, Jin Soo

doi:10.5853/jos.2022.00941

Cited by 22 publications

(28 citation statements)

References 110 publications

(173 reference statements)

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“…31,32 Moreover, removal of the thrombus within ICAD-related LVO may be challenging because of lack of contact between the catheter tip and thrombus with contact aspiration. 33 In patients undergoing percutaneous intervention for ST-segment-elevation myocardial infarction, aspiration thrombectomy has not been demonstrated to improve clinical outcomes in a metaanalysis of 3 randomized trials, 34 and the benefit of primary aspiration for ICAD-related LVO remains to be validated. 31 Differences in respondent preferences by country income were observed for all techniques.…”

Section: Discussionmentioning

confidence: 99%

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Klein

Herning

Drumm

et al. 2023

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BACKGROUND Two recent trials demonstrated a benefit for endovascular therapy (EVT) in the treatment of basilar artery occlusion (BAO). In light of the expected increase in the use of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists performing EVT for BAO. METHODS We conducted an international online survey of physician opinions on the use of EVT in BAO between January and March 2022. The survey was distributed through stroke and neurointerventional organizations. Survey questions examined selection of patients for the procedure and the techniques currently used for EVT in BAO. Responses from neurointerventionalists were analyzed. RESULTS More than 3000 participants were invited yielding 1245 respondents, of whom 543 were classified as neurointerventionalists across 52 countries and included in this analysis. Most neurointerventionalists would proceed to EVT for occlusions of the V4 segment, the basilar artery, or the posterior cerebral artery, without regard for prior intravenous thrombolysis. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method of 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease etiology, combined stent retriever and aspiration thrombectomy was the preferred method of 40.5% of neurointerventionalists. The majority of neurointerventionalists (88.0%) would proceed to stenting after 3 or fewer failed passes for patients with BAO of intracranial atherosclerotic disease etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%). CONCLUSIONS Among the surveyed neurointerventionalists, the most common techniques for EVT of patients with BAO were contact aspiration or combined stent retriever with aspiration thrombectomy. For patients with BAO due to intracranial atherosclerotic disease, the majority of neurointerventionalists were willing to stent and do so most often after 3 or fewer failed passes and with the use of dual antiplatelet medications. Further study is needed to determine the optimal technique for EVT of BAO with or without intracranial atherosclerotic disease. Key Words

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Section: Discussionmentioning

confidence: 99%

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Klein

Herning

Drumm

et al. 2023

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“…However, another two RCTs, BAOCHE (Basilar Artery Occlusion Chinese Endovascular Trial) and ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion), showed the benefit of EVT for acute VBAO 3 4. The favorable outcome (90 day modified Rankin Scale (mRS) score of 0–3) rate in these four RCTs in the EVT groups varied from 42% to 46.4% 5. Therefore, finding strategies to improve the clinical outcome of acute VBAO after EVT is critical.…”

Section: Introductionmentioning

confidence: 94%

First pass effect of mechanical thrombectomy for acute vertebrobasilar artery occlusion: data from the ANGEL-ACT registry

Sun

Huo

Raynald

et al. 2023

J NeuroIntervent Surg

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BackgroundTo explore the incidence, predictors, and association of first pass effect (FPE) on clinical outcomes of mechanical thrombectomy (MT) for acute vertebrobasilar artery occlusion (VBAO) in the Asian population.MethodsWe selected patients from the ANGEL-ACT registry. We defined FPE as complete recanalization after one MT attempt without rescue treatment, multiple pass effect (MPE) as complete recanalization after >1 MT attempt or after one MT attempt with rescue treatment, and incomplete recanalization (ICR) as a modified Thrombolysis in Cerebral Ischemia score of 2b, independent of the number of MT attempts. We conducted multivariable logistic analyses to identify the independent predictors of FPE and to compare the outcomes, including favorable outcome, mortality within 90 days, and intracranial hemorrhage (ICH) among the FPE, MPE, and ICR groups.ResultsTwo hundred and seventy-nine patients, 68 with FPE (24.4%), 114 with MPE (40.9%), and 83 with ICR (29.7%), were included. Underlying intracranial atherosclerosis disease (ICAD) (adjusted OR (aOR) 0.16, 95% CI 0.08 to 0.34, P<0.001) was independently associated with a low chance of FPE. Furthermore, FPE was associated with a favorable outcome compared with MPE and ICR (MPE vs FPE, aOR 0.49, 95% CI 0.25 to 0.97, P=0.040; ICR vs FPE, aOR 0.38, 95% CI 0.18 to 0.81, P=0.012), and decreased mortality (MPE vs FPE, aOR 2.57, 95% CI 1.04 to 6.36, P=0.041) compared with MPE but similar mortality to ICR (P=0.374). No difference was found for ICH among the three groups (P>0.05).ConclusionsFPE occurred in 24.4% of patients with VBAO in our cohort, which was associated with improved clinical outcomes compared with MPE and ICR. VBAO with underlying ICAD was less likely to achieve FPE.Trial registration numberNCT03370939.

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“…In other MT studies targeting patients with basilar artery occlusion, they also classified the patients as vertebrobasilar artery occlusion without separating the patients with vertebral artery occlusion. 7 …”

Section: Authors' Response To the Lettermentioning

confidence: 99%

Letter to the Editor: Assessing the Effect of Thrombectomy up to 24h After Onset of Stroke Requires Large, Prospective, International Studies

Finsterer¹

2023

J Korean Med Sci

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Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy

Cited by 22 publications

References 110 publications

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

First pass effect of mechanical thrombectomy for acute vertebrobasilar artery occlusion: data from the ANGEL-ACT registry

Letter to the Editor: Assessing the Effect of Thrombectomy up to 24h After Onset of Stroke Requires Large, Prospective, International Studies

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