Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window

Uno, Junji; Kameda, Katsuharu; Otsuji, Ryosuke; Ren, Nice; Nagaoka, Shintaro; Maeda, Kazushi; Ikai, Yoshiaki; Gi, Hidefuku

doi:10.1159/000479939

Cited by 30 publications

(20 citation statements)

References 30 publications

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“…6 Our findings of good function outcome in 37% of patients and successful reperfusion in 72% are in agreement with more recent EVT series for patients with BAO. [15][16][17][18][19] The authors report a complication rate of 9%, which is in line with that of the BEST trial which reported symptomatic ICH rate of 8% in the intervention arm. 14 We observed that only baseline NIHSS score, pc-ASPECTS, and BATMAN score were significantly associated with good outcome on univariate analysis, and only the baseline pc-ASPECTS and BATMAN score were significant on multivariate logistic regression analysis.…”

Section: Discussionsupporting

confidence: 72%

Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

Pasarikovski

Khosravani

Costa

et al. 2020

Can. J. Neurol. Sci.

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ABSTRACT:Background and Purpose:Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices.Methods:All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS.Results:A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270–639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome.Conclusion:EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.

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Section: Discussionsupporting

confidence: 72%

Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

Pasarikovski

Khosravani

Costa

et al. 2020

Can. J. Neurol. Sci.

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“…In our cohort, it accounted for three-quarter (n = 75/102) of causative LVOs. There is, however, some evidence from non-randomized studies that EVT of both M2 segment of MCA [12] and basilar artery [13,14] occlusions may result in high recanalization rates and good clinical outcomes. Our study demonstrates that considering MT in broader range of LVO cases (M2, A1, A2, BA, P1), could result in treating one more patient out of ten arriving within the treatment time widow (12%).…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center

Wiącek¹,

Kaczorowski²,

Sieczkowski³

et al. 2018

Neurologia i Neurochirurgia Polska

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“…The 30% overall rate of good outcome (mRS 0-2) at 3 months is similar or better than in previous BAO cohorts treated with IVT or IAT by us [24]and others [5,15] with rates of 21%-33%, and also comparable with many thrombectomy-treated cohorts [6,8,[25][26][27] with rates between 27% and 36%. Conversely, some EVT cohorts have reported higher rates of good outcome of up to 44%-56% [28][29][30][31] These differences may be partly explained by patient selection, treatment chain-related factors or sample sizes. Yoon et al, [30] Baek et al [29] and Kang et al [31] all reported EVT-treated cohorts with lower NIHSS scores and higher prevalence of atrial fibrillation, The changes in outcome trends during the period 1995-2016 are shown in Figure 1 and Table S1.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

Ritvonen

Sairanen

Silvennoinen

et al. 2020

Euro J of Neurology

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Background The data on long‐term outcome after basilar artery occlusion (BAO) are scarce. Little is known about BAO survivors´ outcome over decades. Aim We set out to investigate long‐term survival and causes of death in BAO patients with up to two decades of follow‐up. We also evaluated differences in outcome trends. Methods Two hundred and seven BAO patients treated with intravenous thrombolysis (IVT) at the Department of Neurology, Helsinki University Hospital, between 1995 and 2016, were analyzed. Short‐term outcome was assessed by modified Rankin Scale (mRS) at 3 months. Long‐term cumulative survival rate was analyzed using Kaplan−Meier analysis. Factors associated with mortality were analyzed with Cox regression. Results Moderate outcome (mRS 0–3) was achieved in 41.1% and good outcome (mRS 0–2) in 30.4% of patients at 3 months. Three‐month mortality was 39.6%, of which 89% died within the first month. The median follow‐up time in 3‐month survivors was 8.9 years (maximum 21.8 years). Total mortality during follow‐up was 52.2%. Cumulative mortality rate was 25.7%. Older age, coronary artery disease and more extensive ischemic changes on admission brain imaging were independently associated with long‐term mortality. After the acute phase, the rate of other vascular causes of death increased in relation to stroke. Conclusions The described evolution of a large, single‐center BAO cohort shows a trend towards a higher rate of good and/or moderate outcome during later years in IVT‐treated patients. Survivors showed relative longevity, and the rate of cardiac and other vascular causes of death increased in relation to stroke sequelae over the long term.

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Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Early Therapeutic Time Window

Cited by 30 publications

References 30 publications

Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

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