Endovascular treatment of severe acute basilar artery occlusion

Abstract

Severe acute basilar artery occlusion (BAO) has a high mortality rate but as yet no effective treatment has been developed. This study aimed to evaluate the feasibility and safety of combined mechanical thrombectomy, intra-arterial thrombolysis, and emergent stent placement for patients with severe acute BAO. Eighteen patients who were unconscious after confirmed onset of BAO and who were given arterial interventional treatment from March 2011 to June 2013 at our department were included in this study. The mean age was 59.56 years (range: 31–76 years) and patients were in a critical physical condition upon admission, and had a mean National Institutes of Health Stroke Scale (NIHSS) score of 25.94 (range: 18–35). All patients were treated with mechanical thrombectomy, 10 of whom received mechanical thrombectomy only. Of the others, eight were also treated with intra-arterial thrombolysis, three were treated with emergent stent placement, and 17 were treated with recanalization with an achieved recanalized rate of 94.4%. The average number of passes through the stent was 1.5 (range: 1–3) and five patients died (27.8%). Thirteen patients survived, and the mean NIHSS score was 6.54 (range: 0–16). Seven patients showed a modified Rankin Scale score ≤2, and the rate of good prognoses was 38.9%. In the treatment of patients with severe acute BAO, intra-arterial mechanical thrombectomy combined with thrombolysis or stent placement are effective strategies to restore blood flow and preserve life, and these strategies have a low incidence of complications.

Mechanical thrombectomy with the Solitaire AB stent for treatment of acute basilar artery occlusion: A single-center experience

“…However, those studies all focused on anterior circulation acute stroke; there are no RCT, to our knowledge, on the safety and efficacy of using stent retrievers MT for acute BAO. Further, only a few small-sample-sized retrospective studies have reported clinical findings of MT with stent retrievers in acute BAO [17][18][19][20][21].…”

“…In that study, good functional outcome (mRS 0-2) was achieved in 48% (12/25) of patients, and 88% (22/25) survived to 3 months. Finally, Wang et al [21] reported 18 severe acute BAOs treated with MT. Successful recanalization (TICI 3 or 2b) was obtained in 94.4% (17/18) of patients, with a mean of 1.5 passes.…”

Mechanical Thrombectomy of Acute Basilar Artery Occlusion: Single Center Experience

“…Espinosa de Rueda et al [20] reported, in a series of 18 patients with acute BAO who were directly treated with mechanical thrombectomy with either the Solitaire stent (10/18) or the Trevo stent (8/10), a good outcome was recorded in 50% (9/18), and the mortality rate was 22.3% at 3 months. Wang et al [21] in his personal series of 18 patients with BAO all treated with mechanical thrombectomy (10 patients only with mechanical thrombectomy, 8 patients treated in addition with intra-arterial thrombolysis) reported a recanalization rate of 94.4% with a mortality rate, according to the literature, of 27.8%. The literature shows a contrast between a high recanalization rate and clinically good outcome rate [7,8,11,[19][20][21].…”

“…Wang et al [21] in his personal series of 18 patients with BAO all treated with mechanical thrombectomy (10 patients only with mechanical thrombectomy, 8 patients treated in addition with intra-arterial thrombolysis) reported a recanalization rate of 94.4% with a mortality rate, according to the literature, of 27.8%. The literature shows a contrast between a high recanalization rate and clinically good outcome rate [7,8,11,[19][20][21]. These findings might be attributable to the small personal series, but also to different factors indicated as predictors of outcome as initial NIHSS score, age, time from onset to treatment, thrombus localization [2,3,[22][23][24].…”

The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion

“…Although anticoagulation and antiplatelet method have been widely used in the clinic by many doctors, 80%-90% patients still can not avoid death5. Recent reports have showed that thrombolytic therapy can effectively decrease the mortality rate and greatly improve patients' quality of life 6.…”