Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome

Baik, Sang‐Ho; Park, Hyungjong; Kim, Jun Hwee; Jang, Chang Ki; Kim, Byung Moon; Kim, Dong Joon

doi:10.1148/radiol.2019181924

Cited by 94 publications

(113 citation statements)

References 34 publications

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“…These results suggest that the meniscus sign may be associated with an embolic occlusion rather than an in situ ICAS-related occlusion. Our results also coincide with previous studies suggesting that embolic occlusions are associated with higher recanalization rates than ICAS-related BAO when treated by MT 6 17 20. The meniscus sign also showed a consistently higher recanalization rate irrespective of the location of the occlusion, suggesting the efficacy of this simple and practical imaging biomarker.…”

Section: Discussionsupporting

confidence: 91%

“…On the other hand, the patients without the meniscus sign showed a significantly higher frequency of proximal occlusion and adjacent arterial wall calcifications. Distal BAOs are often associated with an embolic etiology whereas calcifications of the arterial wall suggest an underlying in situ ICAS 6 18 19. Other authors have shown that imaging features similar to the meniscus sign are associated with embolism as the cause of the occlusion 9.…”

Section: Discussionmentioning

confidence: 99%

“…Several factors associated with successful recanalization have been reported. Underlying pathologic subtypes of BAO, collateral status, site of occlusion and first-line strategy have been known to be associated with differing recanalization rates in the setting of acute BAO 2 4–6. Only a small number of previous studies based on thrombolytic treatment have shown the correlation between the angiographic morphologic features of the clot and recanalization.…”

Section: Introductionmentioning

confidence: 99%

“…Only a small number of previous studies based on thrombolytic treatment have shown the correlation between the angiographic morphologic features of the clot and recanalization. In these investigations, angiographic ‘tram-track’ and ‘outline’ appearing in the occlusion site before treatment showed higher rates of successful recanalization 5–7. However, literature on the association of the morphologic features of the clot and treatment outcome in relation to modern mechanical thrombectomy (MT) is scarce 8 9.…”

Section: Introductionmentioning

confidence: 99%

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Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke

Baik

Kim

et al. 2019

J NeuroIntervent Surg

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IntroductionThe relationship between the occlusive clot morphology and the efficacy of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) is not well known. Our aim was to evaluate the clinical significance of the clot meniscus sign in patients with acute BAO.Methods89 patients with acute BAO who underwent MT were retrospectively analyzed. The clot meniscus sign was defined as meniscoid/tram-track like antegrade side-wall contrast opacification of the thrombus. Patients were assigned to two groups based on the presence of the clot meniscus sign. The treatment and clinical outcomes were compared.ResultsThe clot meniscus sign was diagnosed in 62.9% (53/89) of the patients. The meniscus sign (+) group showed a shorter procedure time (55 vs 85 min; p=0.045), higher rate of successful recanalization (89.3% vs 63.6%, p=0.004), higher incidence of first pass effect (32.1% vs 6.1%, p=0.004), and lower number of passes (2 vs 3; p=0.042) when compared with the meniscus sign (−) group. The procedure time (OR 0.972, 95% CI 0.962 to 0.992; p=0.003) and clot meniscus sign (OR 7.920, 95% CI 1.769 to 35.452; p=0.007) were independent predictors of successful recanalization.ConclusionThe clot meniscus sign is related to high first pass effect and short procedure time and is a reliable predictor of successful recanalization in patients with acute BAO.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke

Baik

Kim

et al. 2019

J NeuroIntervent Surg

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“…Its efficacy for posterior circulation acute ischemic stroke has also been suggested, 7) but several studies reported that the addition of percutaneous transluminal angioplasty (PTA) was necessary when arteriosclerotic stenosis was detected at the site of occlusion during mechanical thrombectomy. [8][9][10] The presence of arteriosclerotic stenosis at the site of occlusion prevents early recanalization. This study investigated the usefulness of preoperative postcontrast computed tomography (pcCT) for the diagnosis of vertebral/BA occlusion and estimation of the presence of arteriosclerotic stenosis at the site of occlusion.…”

Section: Introductionmentioning

confidence: 99%

Postcontrast CT to Estimate Arteriosclerotic Stenosis at the Site of Occlusion before Emergency Endovascular Treatment for Vertebral–Basilar Artery Occlusion

Yoshioka

Mori

2021

JNET

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Thrombectomy may be an effective therapy for vertebrobasilar artery (VBA) occlusion in addition to carotid or middle cerebral artery occlusion. Underlying arterial stenosis can be a cause of failure in thrombectomy; however, it is difficult to identify candidates with VBA occlusion before thrombectomy. The purpose of our study was to investigate whether postcontrast computed tomography (pcCT) is useful for identifying candidates with VBA occlusion for thrombectomy. Methods: In this retrospective study, we included patients who 1) were admitted to our institution between January 1, 2013, and July 1, 2019; 2) underwent pcCT; and 3) underwent emergency endovascular therapy for VBA occlusion. We defined no opacification of the top of the basilar artery (BA) in reconstructed coronal images of pcCT scans as distal BA occlusion and opacification of the top of the BA as distal BA open. We assessed the presence of underlying arterial stenosis at the site of occlusion according to angiographic findings during endovascular procedures. We also evaluated the relationship between the distal BA findings and the presence of underlying arterial stenosis. Results: Thirty-two patients met our inclusion criteria and were analyzed. Among 19 patients with distal BA occlusion, none (0%) had ischemic stroke with underlying arterial stenosis. Among 13 patients with distal BA open, 4 (31%) were diagnosed with ischemic stroke without underlying arterial stenosis and 9 (69%) with underlying arterial stenosis (p <0.001). Conclusion: Distal basilar-artery findings in reconstructed coronal postcontrast CT images were useful for identifying candidates with VBA occlusion for thrombectomy. Keywords▶ vertebrobasilar artery occlusion, endovascular thrombectomy This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry

Zi¹,

Qiu²,

Wu³

et al. 2020

JAMA Neurol

252

222

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Writing Group for the BASILAR Group IMPORTANCE Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT.OBJECTIVE To evaluate the association between EVT and clinical outcomes of patients with acute BAO. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. MAIN OUTCOMES AND MEASURESThe primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality.RESULTS A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI,; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001).CONCLUSIONS AND RELEVANCE Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.

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Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome

Cited by 94 publications

References 34 publications

Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke

Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke

Postcontrast CT to Estimate Arteriosclerotic Stenosis at the Site of Occlusion before Emergency Endovascular Treatment for Vertebral–Basilar Artery Occlusion

Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry

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