Frontline thrombectomy strategy and outcome in acute basilar artery occlusion.

Abstract

BACKGROUND:

Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO).

PURPOSE:

To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO.

METHODS:

Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0-2.

RESULTS:

Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate.

CONCLUSION:

Among BAO patients, the combined technique effectively contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.

• Authors: Mohamed Abdelrady, Julien Ognard, Federico Cagnazzo, Imad Derraz, Pierre-Henri Lefevre, Carlos Riquelme, Gregory Gascou, Caroline Arquizan, Cyril Dargazanli, Mourad Cheddad El Aouni, Douraied Ben Salem, Isabelle Mourand, Vincent Costalat, Jean Christophe Gentric, RAMBO (Revascularization via Aspiration or Mechanical thrombectomy in Basilar Occlusion)
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 15 Issue 1 Pg. 27-33 (Jan 2023) ISSN: 1759-8486 [Electronic] England
• PMID: 34992148 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Humans
• Arterial Occlusive Diseases (diagnostic imaging, surgery)
• Basilar Artery (diagnostic imaging, surgery)
• Retrospective Studies
• Stents
• Stroke
• Thrombectomy (adverse effects, methods)
• Treatment Outcome
• Registries