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

Du, Shiwei; Mao, Gengsheng; Li, Dongmei; Qiu, Ming; Nie, Qingbin; Zhu, Haibo; Yang, Yang; Zhang, Youping; Li, Youxiang; Wu, Zhongxue

doi:10.1016/j.jocn.2016.01.037

Cited by 18 publications

(11 citation statements)

References 38 publications

(52 reference statements)

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“…A significantly increased risk of poor outcome seems to occur when recanalization therapy is started more than 6 h, after symptom onset of acute BAO. [ 15 17 ] In our study, despite delayed intervention, clinical outcome was not statistically significant. We were able to achieve successful revascularization in 21 (84%) cases with mean needle to recanalization min 42.20 (±19.4).…”

Section: Discussioncontrasting

confidence: 63%

“…[ 12 ] BAO also has highest mortality rate of all types of ischemic stroke, with a morbidity and mortality rate of acute BAO of 80%–90% without active intervention. [ 15 ] The therapeutic time window for endovascular therapy in acute occlusion of BA remains unknown. [ 16 ] The PC system may have a stronger tolerance to ischemia and hypoxia due to greater white matter structure and better collaterals than AC.…”

Section: Discussionmentioning

confidence: 99%

“…using Solitaire device, the mean time from symptom onset to recanalization was 579.00 ± 188.78 min (range: 360–960 min), and 38.1% of patients had a good clinical outcome at 3 months follow-up. [ 15 ] In a recent meta-analysis of stent retriever thrombectomy in BAO, which pooled the event rates for mortality in 15 observational series, the mortality rates were highly variable among all studies ranging from 6% to 46%. [ 17 ] In our study, we observed mortality rate of 8% in PC group.…”

Section: Discussionmentioning

confidence: 99%

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Acute ischemic stroke treatment using mechanical thrombectomy: A study of 137 patients

Singh

Chafale

Lalla

et al. 2017

Ann Indian Acad Neurol

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute ischemic stroke treatment using mechanical thrombectomy: A study of 137 patients

Singh

Chafale

Lalla

et al. 2017

Ann Indian Acad Neurol

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“…This could be attributed to the fact that most patients undergoing IAT in the posterior circulation have BAO, and strokes attributed to BAO lead to higher morbidity and mortality rates, and more severe disability. 24,25 Although studies that investigated IAT in PCS by BAO were limited, they revealed that BAO patients treated by IAT had a poorer functional outcome and higher mortality rates than ACS patients. 24,25 Notably, several studies on PCS have revealed that performing IAT within the first 6-8 h in acute ischemic stroke caused by BAO could yield positive outcomes.…”

Section: Discussionmentioning

confidence: 99%

Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis

Han

Jung

2020

International Journal of Stroke

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Background It remains unclear whether thrombolysis outcomes can be influenced by the affected vascular territory (i.e. anterior circulation stroke vs. posterior circulation stroke) in stroke patients owing to the lack of randomized controlled trials. Aims Using multiple comprehensive databases, we searched for observational studies of the safety and efficacy of intravenous thrombolytics and intra-arterial treatment with or without intravenous thrombolytics in accordance with the affected vascular territory. We performed a systematic review and meta-analysis. We evaluated symptomatic intracerebral hemorrhage, all-type intracerebral hemorrhage, mortality, and functional outcomes at three months. The recanalization rate was assessed in the intra-arterial treatment group. Summary of review Twenty-one studies including a report from our own stroke registry were included through quantitative synthesis. Compared with the anterior circulation stroke group, the posterior circulation stroke group had a lower risk of ICH, including symptomatic intracerebral hemorrhage and all-type intracerebral hemorrhage, after intravenous thrombolytics and tended to have favorable functional outcomes at three months. Mortality was similar between the two groups. Regarding intra-arterial treatment, the symptomatic intracerebral hemorrhage and post-procedural recanalization rates were comparable between the two groups, although the posterior circulation stroke group had a higher mortality risk and lower tendency for a favorable functional outcome. Conclusions Safety and efficacy of thrombolysis in posterior circulation stroke depends on involvement of large vessel occlusion and reperfusion modality such that intravenous thrombolytics is more effective and safer than in anterior circulation stroke; the safety and efficacy of intra-arterial treatment is comparable or lower than anterior circulation stroke. Considering the limitations of our meta-analysis, further studies are needed to provide high level evidence of a beneficial effect of intra-arterial treatment, and to identify patients’ profiles associated with benefit of treatment.

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“…Recently, retrospective case series have demonstrated acceptable results of functional outcome for BAO or PCO treated with MT [9][10][11] . There is no doubt that the best way to identify the effect of MT in patients with PCO is through conducting a randomized controlled trial and comparing MT to intravenous thrombolysis alone, but such trial may not be feasible due to the lack of clinical equipoise that MT is performed for patients with PCO in many institutions in a real world.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Mechanical Thrombectomy for Posterior Circulation Occlusion: A Comparison of Outcomes with the Anterior Circulation Occlusion – A Meta-Analysis

Wang

et al. 2020

JAT

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There is no randomized controlled trial to compare the effectiveness and safety of mechanical thrombectomy (MT) to intravenous thrombolysis in patients with posterior circulation occlusion (PCO). Hence, we firstly performed a meta-analysis to investigate the outcomes of MT in PCO and then compared these outcomes to anterior circulation occlusion (ACO) to provide fundamental data to further studies. Methods: We searched the PubMed, EMBASE, and Cochrane Library from dates of inception to June 2019 for relevant studies. Outcomes including functional independence at 90 days, successful recanalization, mortality, symptomatic intracranial hemorrhage (sICH), and futile recanalization were extracted. Results: Seven studies involving 474 patients with PCO thrombectomy were analyzed. There was a lower rate of functional independence at 90 days and a higher rate of mortality after thrombectomy in PCO versus ACO (odds ratios (OR) 0.72; 95% confidence interval (CI) 0.57-0.90; OR 2.03; 95% CI 1.30-3.18). Recanalization rates were comparable (OR 1.01; 95% CI 0.62-1.65), but a higher futile recanalization rate was found in basilar artery occlusion (BAO) (OR 1.75; 95% CI 1.30-2.37). There was a lower rate of sICH in MT for patients with PCO versus ACO (OR 0.54; 95% CI 0.29-0.99). Conclusions: We found that the outcomes of MT for patients with PCO were poorer than with ACO. On the other hand, MT appears to have lower rates of sICH and to increase successful recanalization. Given the high recanalization rate, MT may serve as an adjunct to standard treatment. The key point to improve outcomes is recognizing reliable factors associated with futile recanalization and optimizing the results of MT. But in view of the different characteristics of posterior circulation stroke and anterior circulation stroke, the results are far from robust. acute ischemic stroke due to large vessel occlusion in the anterior circulation demonstrated an overwhelming benefit of the new generations of mechanical thrombectomy (MT) devices compared to intravenous thrombolysis 2-6) , grounded on which American Heart Association/American Stroke Association guidelines Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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

Cited by 18 publications

References 38 publications

Acute ischemic stroke treatment using mechanical thrombectomy: A study of 137 patients

Acute ischemic stroke treatment using mechanical thrombectomy: A study of 137 patients

Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis

Mechanical Thrombectomy for Posterior Circulation Occlusion: A Comparison of Outcomes with the Anterior Circulation Occlusion – A Meta-Analysis

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