Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation
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Open Access
- 25 June 2019
- journal article
- research article
- Published by BMJ in Journal of NeuroInterventional Surgery
- Vol. 11 (12), 1174-1180
- https://doi.org/10.1136/neurintsurg-2018-014516
Abstract
Background Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based. Objective To compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT. Methods In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms. Results MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO. Conclusions In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR. Trial registration number NCT03496064Keywords
This publication has 54 references indexed in Scilit:
- The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trialTrials, 2013
- Outcomes of basilar artery occlusion in patients aged 75 years or older in the Basilar Artery International Cooperation StudyZeitschrift für Neurologie, 2012
- Basilar artery occlusionLancet Neurology, 2011
- Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation StrokeStroke, 2011
- Three-Month and Long-Term Outcomes and Their Predictors in Acute Basilar Artery Occlusion Treated With Intra-Arterial ThrombolysisStroke, 2011
- Significance of Large Vessel Intracranial Occlusion Causing Acute Ischemic Stroke and TIAStroke, 2009
- Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry studyThe Lancet Neurology, 2009
- Therapy of Basilar Artery OcclusionStroke, 2006
- Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic StrokeStroke, 2003
- Thrombolytic Therapy of Acute Basilar Artery OcclusionStroke, 1996