Forced Arterial Suction Thrombectomy with the Penumbra Reperfusion Catheter in Acute Basilar Artery Occlusion: A Retrospective Comparison Study in 2 Korean University Hospitals
Open Access
- 17 July 2014
- journal article
- research article
- Published by American Society of Neuroradiology (ASNR) in American Journal of Neuroradiology
- Vol. 35 (12), 2354-2359
- https://doi.org/10.3174/ajnr.a4045
Abstract
BACKGROUND AND PURPOSE: A performance of forced arterial suction thrombectomy was not reported for the treatment of acute basilar artery occlusion. This study compared revascularization performance between intra-arterial fibrinolytic treatment and forced arterial suction thrombectomy with a Penumbra reperfusion catheter in patients with acute basilar artery occlusion. MATERIALS AND METHODS: Fifty-seven patients with acute basilar artery occlusion were treated with intra-arterial fibrinolysis (n = 25) or forced arterial suction thrombectomy (n = 32). Baseline characteristics, successful revascularization rate, and clinical outcomes were compared between the groups. RESULTS: Baseline characteristics, the frequency of patients receiving intravenous recombinant tissue plasminogen activator, and mean time interval between symptom onset and femoral puncture did not differ between groups. The forced arterial suction thrombectomy group had a shorter procedure duration (75.5 minutes versus 113.3 minutes, P = .016) and higher successful revascularization rate (88% versus 60%, P = .017) than the fibrinolysis group. Fair outcome, indicated by a modified Rankin Scale 0–3, at 3 months was achieved in 34% of patients undergoing forced arterial suction thrombectomy and 8% of patients undergoing fibrinolysis (P = .019), and the mortality rate was significantly higher in the fibrinolysis group (25% versus 68%, P = .001). Multiple logistic regression analysis identified the forced arterial suction thrombectomy method as an independent predictor of fair outcome with adjustment for age, sex, initial NIHSS score, and the use of intravenous recombinant tissue plasminogen activator (odds ratio, 7.768; 95% CI, 1.246–48.416; P = .028). CONCLUSIONS: In acute basilar artery occlusion, forced arterial suction thrombectomy demonstrated a higher revascularization rate and improved clinical outcome compared with traditional intra-arterial fibrinolysis. Further clinical trials with the newer Penumbra catheter are warranted.Keywords
This publication has 31 references indexed in Scilit:
- First Experiences with a New Device for Mechanical Thrombectomy in Acute Basilar Artery OcclusionCerebrovascular Diseases, 2011
- Drip, Ship, and RetrieveStroke, 2010
- Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry studyThe Lancet Neurology, 2009
- Staged Escalation Therapy in Acute Basilar Artery OcclusionStroke, 2008
- Basilar Artery ThrombosisStroke, 2006
- Complete Nonvisualization of Basilar Artery on MR Angiography in Patients with Vertebrobasilar Ischemic Stroke: Favorable Outcome FactorsCerebrovascular Diseases, 2004
- New England medical center posterior circulation registryAnnals of Neurology, 2004
- Endovascular Therapy of Acute Vertebrobasilar Occlusion: Early Treatment Onset as the Most Important FactorCerebrovascular Diseases, 2002
- Intra-arterial Prourokinase for Acute Ischemic StrokeJama-Journal Of The American Medical Association, 1999
- Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease.Stroke, 1988