Posterior Circulation Endovascular Thrombectomy for Large-Vessel Occlusion: Predictors of Favorable Clinical Outcome and Analysis of First-Pass Effect

Abstract

BACKGROUND AND PURPOSE: Successful vessel recanalization in posterior circulation large-vessel occlusion is considered crucial, though the evidence of clinical usefulness, compared with the anterior circulation, is not still determined. The aim of this study was to evaluate predictors of favorable clinical outcome and to analyze the effect of first-pass thrombectomy. MATERIALS AND METHODS:A retrospective, multicenter, observational study was conducted in 10 high-volume stroke centers in Europe, including the period from January 2016 to July 2019. Only patients with an acute basilar artery occlusion or a single, dominant vertebral artery occlusion ("functional" basilar artery occlusion) who had a 3-month mRS were included. Clinical, procedural, and radiologic data were evaluated, and the association between these parameters and both the functional outcome and the firstpass effect was assessed.RESULTS: A total of 191 patients were included. A lower baseline NIHSS score (adjusted OR, 0.77; 95% CI, 0.61-0.96; P ¼ .025) and higher baseline MR imaging posterior circulation ASPECTS (adjusted OR, 3.01; 95% CI, 1.03-8.76; P ¼ .043) were predictors of better outcomes. The use of large-bore catheters (adjusted OR, 2.25; 95% CI, 1.08-4.67; P ¼ .030) was a positive predictor of successful reperfusion at firstpass, while the use of a combined technique was a negative predictor (adjusted OR, 0.26; 95% CI, 0.09-0.76; P ¼ .014). CONCLUSIONS:The analysis of our retrospective series demonstrates that a lower baseline NIHSS score and a higher MR imaging posterior circulation ASPECTS were predictors of good clinical outcome. The use of large-bore catheters was a positive predictor of first-pass modified TICI 2b/3; the use of a combined technique was a negative predictor.ABBREVIATIONS: BAO ¼ basilar artery occlusion; F-P mTICI ¼ first-pass effect mTICI; IQR ¼ interquartile range; mTICI ¼ modified TICI; pc-ASPECTS ¼ posterior circulation ASPECTS; pc-LVO ¼ large-vessel occlusion of the posterior circulation P osterior circulation stroke accounts for about 20% of all ischemic stroke cases. 1,2 The etiology is variable (thromboembolic, atherosclerosis, arterial dissection, perforating vessels disease, and so forth), affecting different vascular territories; rarely, this type of stroke is due to a large-vessel occlusion of the posterior circulation (pc-LVO), representing about 1% of all acute ischemic strokes, 3,4 Acute pc-LVO carries a high risk of disabling stroke or death. In this context, designing a randomized controlled trial is challenging, and even appropriate patient selection is problematic. Successful vessel recanalization is considered crucial for survival or for improving functional outcome, 5,6 though the evidence of the clinical usefulness of endovascular

Revascularization Outcome Prediction for A Direct Aspiration-First Pass Technique (ADAPT) from Pre-Treatment Imaging and Machine Learning

“…Recent studies have identified other predictors of functional and reperfusion outcomes after mechanical thrombectomy [21][22][23]. These primarily include demographic features, medical history and preliminary stroke characteristics.…”

“…These primarily include demographic features, medical history and preliminary stroke characteristics. For example, Alexandre et al, in a retrospective, multi-center, observational study of 191 patients with posterior circulation occlusion, found lower baseline NIHSS and higher ASPECTS (Alberta Stroke Program Early CT Score) to be predictors of better functional outcome, and the use of larger bore catheters as a positive predictor of successful reperfusion [21]. Focusing on FPE, Velagupadi et al investigated a cohort of 220 patients who underwent MT, and used demographic characteristics, medical history and stroke characteristics for machine learning analysis of first pass reperfusion prediction [22].…”

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

“…Anyhow, the evaluation of the score is difficult with CT, due to posterior fossa beam hardening artefacts, particularly in the brainstem; these limits may cause low sensitivity and great interobserver variability [21]. On the contrary, MRI is an independent predictor of good clinical outcome prior to endovascular procedures [22], while the probability of good outcome rapidly decreases at each MRI pc-ASPECTS point drop [23].…”

Time is Brain – präklinische Notfallversorgung des akuten ischämischen Schlaganfalls

“…Die Datenlage zu Thrombektomien im vertebrobasilären Stromgebiet ist hingegen gering. Einzelne Studien zeigen jedoch auch hier den Nutzen der Thrombektomie, insbesondere bei Large Vessel Occlusion (LVO) [11].…”