Outcomes of Endovascular Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator for the Treatment of Vertebrobasilar Stroke

Abstract

Background and PurposeAggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. A large administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posterior-circulation (vertebrobasilar) strokes. Outcomes were compared across age groups.MethodsThe United States Nationwide Inpatient Sample was used to evaluate the outcomes of patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay, rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50-64, and ≥65 years). Chi-squared test and Student's t-test were used for comparisons of categorical and continuous variables, respectively.ResultsDuring 2006-2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631 (1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for those aged <50 years than for those aged 50-64 years (30.4% versus 47.4%, p<0.01) and those aged ≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IV-tPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% for patients aged 50-64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92).ConclusionsPatients requiring IV-tPA and/or mechanical thrombectomy for the treatment of posterior-circulation strokes suffer from high mortality rates. Increased age is associated with significantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

“…Previous studies have investigated the efficacy of mechanical thrombectomy in patients with acute ischemic stroke caused by severe local atherosclerotic stenosis and distant embolization (3)(4)(5)8,10,14,15). However, it is possible that different mechanisms of acute ischemic stroke may results in different patient prognosis and hence this study only enrolled patients with acute ischemic stroke caused by VBAO due to severe local atherosclerotic stenosis.…”

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

“…However, the types of devices used during that period were not reported. 24 Time to treatment and reperfusion. The positive effect in the MR CLEAN trial was time dependent, with acOR decreasing from 3.0 (95% CI: 1.6-5.6) at 3.5 h onset to reperfusion time, to 1.5 (95% CI: 1.1-2.2) at 6 h. 25 Treatment effect was not statistically significant anymore when reperfusion was achieved after 6 h 19 m. The benefit of thrombectomy was also shown to be time dependent in IMS III, where increased time to reperfusion was associated with a decreased probability of good functional outcome (adjusted relative risk for every 30-min delay 0Á88, 95% CI 0Á80-0Á98).…”

Smog Sign: Hazy Diffusion-weighted Imaging Restriction in Dense Axonal Tracts in the Pons on Hyperacute MRI with Remarkable Clinical Improvement After Intra-arterial Thrombectomy

“…Basilar artery occlusion (BAO) is one of the most devastating forms of stroke and bears a grave prognosis if not successfully recanalized or revascularized [13-14]. Although in this case, successful IAT was performed within six hours of stroke onset, all major CSCs still perform IAT for life-threatening BAO cases as late as 24 hours from stroke onset [15].…”