Mechanical Thrombectomy of Acute Basilar Artery Occlusion: Single Center Experience

Abstract

Purpose: Acute basilar artery occlusion (BAO) is a devastating neurological condition associated with a poor clinical outcome and a high mortality rate. Mechanical thrombectomy using a retrievable stent applied shortly after symptom onset could increase a good functional outcome, improving survival rate in patients with acute BAO. First clinical trials using stent retrievers have shown promising high recanalization rates. This study aimed to evaluate the feasibility, safety and efficacy of mechanical thrombectomy. Material and Methods:Seven consecutive patients (2 female, 5 male) with a mean age of 59,4 (range 40-82) with acute BAO undergone to endovascular therapy: all patients were treated with mechanical thrombectomy using a retrievable stent (in 5 patients with Solitaire-Covidien system, in 2 patients Revive-Codman system); two of these received in addition a intra-arterial thrombolysis (IAT), one was additionally treated with intra-venous thrombolysis (IVT). Successful recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) grade 2b or 3. Good outcome was defined as modified Rankin Scale (mRS) score of 0-2 at 3 months. Results:Median NIHSS score at onset was 15,8 (range 12-22). Median procedure time to maximal recanalization was 72 minutes (range 35-135). Recanalization was achieved in 100% (7/7) of patients. One symptomatic parenchymal hemorrhage occurred in a patient treated additionally with intra-arterial thrombolysis. Median NIHSS score at 7 days from treatment was 7,2 (range 0-20). At 3 months a good outcome (mRS 0-2) was observed in 71,4% (5/7); overall mortality at 3 months was 28,6% (2/7). Conclusion:Mechanical thrombectomy in BAO presents high recanalization rate, with a very low complication rate, improving good outcome and survival rates in patients with BAO.