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Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

Authors :
Meinel, Thomas Raphael
Kaesmacher, Johannes
Chaloulos-Iakovidis, Panagiotis
Panos, Leonidas
Mordasini, Pasquale
Mosimann, Pascal J
Michel, Patrik
Hajdu, Steven
Ribo, Marc
Requena, Manuel
Maegerlein, Christian
Friedrich, Benjamin
Costalat, Vincent
Benali, Amel
Pierot, Laurent
Gawlitza, Matthias
Schaafsma, Joanna
Pereira, Vitor M
Gralla, Jan
Fischer, Urs
Source :
Journal of Neurointerventional Surgery; 2019, Vol. 11 Issue: 12 p1174-1180, 7p
Publication Year :
2019

Abstract

BackgroundPerforming mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.ObjectiveTo compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.MethodsIn 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.ResultsMT 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.ConclusionsIn 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 numberNCT03496064

Details

Language :
English
ISSN :
17598478 and 17598486
Volume :
11
Issue :
12
Database :
Supplemental Index
Journal :
Journal of Neurointerventional Surgery
Publication Type :
Periodical
Accession number :
ejs51559764
Full Text :
https://doi.org/10.1136/neurintsurg-2018-014516