First Experiences with a New Device for Mechanical Thrombectomy in Acute Basilar Artery Occlusion

Abstract

Background and Purpose: The aim of this study was to evaluate our first results using a new device for mechanical thrombectomy in patients with acute basilar artery occlusion. Methods: Between May 2009 and September 2010 a new device for aspiration thrombectomy (The Penumbra System™; Penumbra Inc., Alameda, Calif., USA) was used in 12 patients with acute basilar artery occlusion. We performed a retrospective review of these patients’ medical records. Results: One patient received endovascular treatment without intravenous (IV) thrombolysis because of infarction on the initial CT scan. Eleven of 12 patients received IV thrombolysis with rtPA followed by endovascular thrombectomy according to a bridging concept. After thrombolysis, the basilar artery was patent in 1 patient (9%), partially recanalized in 3 (27%) and still occluded in 7 (64%). The endovascular device could not access in 2 patients (17%). Among the remaining 10 patients, the patency rate after thrombectomy was 100%. The overall patency rate after treatment was 9 of 12 (75%) at the time of discharge. National Institute of Health Stroke Scale improved from a median of 27 to a median of 18 after treatment. Four patients died (33%). The survivors had a mean modified Rankin Scale before discharge of 2.3 (range 0–4). Conclusions: A bridging therapy with the combination of IV thrombolysis with recombinant tissue plasminogen activator and continuous aspiration thrombectomy seems to be a promising therapy strategy for acute basilar artery occlusion. Furthermore, our results confirm the advantage of the additional use of this new thrombectomy device, working with thrombus aspiration, with a satisfactory patency rate and a good clinical outcome.

Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device

“…3 Early recanalization remains the main important factor that can improve outcome. [4][5][6] However, even though the best recanalization rate is achieved by using a newer stent retriever, such as a Solitaire FR Device (Covidien, Irvine, California) (up to 100%), [7][8][9][10] stent retriever impact on functional outcome is not as clear-cut as expected and has not been documented in a randomized trial. The extent of baseline brain stem ischemic damage can also influence outcome.…”

An asymmetrical fenestration of the basilar artery coexisting with two aneurysms in a patient with subarachnoid haemorrhage: case report and review of the literature

“…This has become more important in the era of new therapeutic options for intracranial intervention including use of vertebral artery stents, endovascular thrombectomy and endovascular thrombolysis [17,19,24]. To the best of our knowledge, asymmetrical fenestration of the basilar artery together with coexistence of the SAH and 2 aneurysms has not been previously reported.…”

“…Also, Islak et al [13] described that 10 of 11 basilar artery fenestration aneurysms were occluded completely. They reported that of the 11 cases, 5 were cases of wide-necked aneurysms, and the balloon remodelling technique was used in 3 cases [19].…”

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

“…Mattle et al 42 reviewed three pilot studies with a total of 29 patients with BAO and reported at least 90% recanalization rate, 31% mortality rate and 45% favorable outcome (mRS 0 -2) among survivors. However, these trials differed in the proportional representation of BAO and pre-post-Solitaire TM treatment method and proportion [43][44][45] . In a recent study, Mordasini et al presented 14 consecutive patients with BAO treated with Solitaire TM with on demand addition of multimodal therapy approaches, such as for example thromboaspiration, IV and/or IA thrombolysis, and percutaneous transluminal angioplasty/permanent stent placement 45 .…”

“…At 3 months, good functional outcome (mRS 0 -2) was observed in 28.6% (4/14) patients and overall mortality was 35.7% (5/14). Hemorrhagic complications were referred in up to 3% of BAO patients undergoing mechanical clot extraction [43][44][45][46][47] . Although Solitaire TM may be used as the first line treatment, difficult situations can arise subsequently requiring additional procedures such as permanent stent or balloon angioplasty 46,48 .…”