Successful recanalization in acute basilar artery occlusion treated with endovascular therapy is independent of thrombus length

Shen, Liang; Riedel, Christian; Meyne, Johannes; Jansen, Olav; Jensen‐Kondering, Ulf

doi:10.1136/neurintsurg-2016-012634

Cited by 29 publications

(20 citation statements)

References 26 publications

(30 reference statements)

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“…In a recent meta-analysis on stent-retriever thrombectomy of BAO, pooled mortality was 29.4% 9. Successful recanalization is fundamental for reducing mortality as well as for a good clinical outcome 11 25 26…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

Piechowiak

Kaesmacher

Zibold

et al. 2019

J NeuroIntervent Surg

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Background and purposeAcute basilar artery occlusion (BAO) is a devastating disease with a high rate of mortality and morbidity, and early recanalization is crucial to achieve a good prognosis. The best treatment strategy for BAO combined with a proximal stenosis (tandem occlusion) is not yet clear. Our study aimed to evaluate whether and how vertebrobasilar tandem occlusions can be treated effectively and safely compared with isolated BAO.Materials and methodsFifty-two patients with acute vertebrobasilar occlusive stroke treated with mechanical thrombectomy were identified in a prospective database from March 2010 to September 2016. We retrospectively analysed the clinical, technical, and functional outcomes of the patients.ResultsOf the 52 patients, 15 presented with a tandem occlusion, 14 with a single intracranial occlusion due to an underlying stenosis, and 23 with a single embolic BAO. Successful recanalization was achieved in all of the patients with tandem occlusions (modified Thrombolysis in Cranial Infarction 2b/3) and in 35 of 37 patients with a single BAO (with and without stenosis). A favourable outcome was achieved (modified Rankin Scale ≤2) in 8 of the 15 patients with a tandem occlusion compared with 4 of the 14 patients with a single BAO with underlying stenosis and 5 of the 23 patients with isolated embolic BAO (p=0.18).ConclusionsWe suggest that endovascular treatment of vertebrobasilar tandem occlusions is safe and feasible, with a high rate of good outcome.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

Piechowiak

Kaesmacher

Zibold

et al. 2019

J NeuroIntervent Surg

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“…81 Successful recanalization has been found not to depend on thrombus length and can be achieved despite a high clot burden. 82 While mechanical thrombectomy in the basilar artery has been associated with more procedural complications than in anterior circulation strokes, 83 failure of successful recanalization was a strong predictor of mortality in a prospective registry of 117 consecutive patients with BAO treated with either stent retrievers or large bore distal aspiration catheters. In the setting of recanalization, a lower pc-ASPECTS (OR 1.71, 95% CI 1.19 to 2.44) and angioplasty/stenting of the basilar artery (OR 4.71, 95% CI 1.34 to 16.54) were independent predictors of mortality after thrombectomy.…”

Section: Emergent Surgical Decompression In Patients With Cerebellar mentioning

confidence: 99%

Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Kayan

Meyers

Prestigiacomo

et al. 2019

J NeuroIntervent Surg

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BackgroundThe aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO).MethodsWe performed a review of the literature to specifically evaluate this disease and its treatments.ResultsData were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus.ConclusionWhile many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment.

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“…A total of 439 AIS cases that underwent MT were included in the meta-analysis. The measurement of thrombus density was on 5-mm-thickness NECT in most studies, while Shu et al (21) used 2.5-mm NECT and we used 1-mm NECT. Most studies included anterior circulation AIS patients, while Shu et al (21) reported 51 cases of posterior circulation stroke; Jagani et al (22) also included 19 (16%) cases.…”

Section: Resultsmentioning

confidence: 99%

Association Between Thrombus Density and Reperfusion Outcomes Using Different Thrombectomy Strategies: A Single-Center Study and Meta-Analysis

Cao

et al. 2019

Front. Neurol.

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Background: For patients with acute ischemic stroke (AIS), the thrombus density on non-enhanced CT (NECT) indicates the composition of the thrombus, a characteristic that impacts the efficacy of mechanical thrombectomy (MT). A previous meta-analysis suggested a correlation between higher thrombus density and successful reperfusion, but some new studies have drawn different conclusions. This single-center study and meta-analysis aimed to detect the association between thrombus density and reperfusion outcomes based on various thrombectomy strategies. Methods: We reviewed AIS patients who underwent MT at our center between July 2015 and May 2019. Thrombus density was recorded as mean Hounsfield Unit (HU) value on 1-mm reconstructed NECT, and expanded Thrombolysis In Cerebral Infarction (eTICI) scale was used to evaluate the reperfusion grade. The difference in thrombus density was examined according to reperfusion outcomes. Then, we systematically searched relevant literature on this issue. The random effect model was used to calculate standardized mean difference (SMD), and subgroup analysis was conducted according to MT strategies employed, including stent retriever (SR), contact aspiration (CA), Solumbra (a combination of SR and aspiration), and multiple thrombectomy modalities. Results: Sixty-four patients with anterior circulation AIS were included in our single-center study with 57 (89.1%) achieving successful reperfusion (eTICI2b-3). Retrospective analysis showed no significant difference in thrombus density between eTICI2b-3 and eTICI0-2a reperfusion (65.27 vs. 62.19, p = 0.462). As for systematic review, 11 studies were included in qualitative analysis, among which 6 had data available for meta-analysis. Pooled result showed that a comparable thrombus density between eTICI2b-3 and eTICI0-2a reperfusion (SMD 0.14, 95%CI −0.28 to 0.57, p = 0.50). Interestingly, in the SR subgroup, eTICI2b-3 reperfusion showed a significant higher thrombus density (SMD 0.53, 95%CI 0.10 to 0.96, p = 0.02), while an inverse trend was observed in the CA subgroup (SMD −0.48, 95%CI −0.88 to −0.07, p = 0.02). Conclusions: Although the pooled result of meta-analysis did not show a significant association between thrombus density and successful reperfusion, subgroup analysis implicated that the SR technique might be prone to retrieve high-density thrombus, while the CA subgroup showed an opposite tendency. Further studies are needed to confirm these results and to investigate its role in the optimization of thrombectomy strategy.

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Successful recanalization in acute basilar artery occlusion treated with endovascular therapy is independent of thrombus length

Abstract: Successful recanalization does not depend on thrombus length in patients with BAO treated with EVT. Recanalization can therefore be achieved despite high clot burden. Additionally, a high density of thrombi was a strong predictor of a favorable outcome.

Cited by 29 publications

References 26 publications

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Association Between Thrombus Density and Reperfusion Outcomes Using Different Thrombectomy Strategies: A Single-Center Study and Meta-Analysis

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