A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study

Abstract

OBJECTIVE Contrary to acute ischemic stroke involving the anterior circulation, no randomized trial has yet demonstrated the safety and effectiveness of endovascular management in acute basilar artery occlusion (BAO). Recently developed thrombectomy devices, such as stentrievers and aspiration systems, have helped in improving the endovascular management of acute ischemic stroke. The authors sought to assess the impact of these devices in the endovascular treatment of acute BAO. METHODS A retrospective analysis of 34 consecutive patients treated in Pitié-Salpêtrière Hospital for acute BAO was carried out. All patients had undergone an endovascular procedure. In addition to the global results in terms of safety and effectiveness (recanalization rate and 3-month clinical outcome based on the modified Rankin Scale [mRS]), the authors aimed to determine if the patients treated with the most recently developed devices (i.e., the Solitaire stentriever or the ADAPT catheter) had better angiographic and clinical outcomes than those treated with older endovascular strategies. RESULTS The overall successful recanalization rate (thrombolysis in cerebral infarction score 2b-3) was 50% (17 of 34 patients). A good clinical outcome (mRS score 0-2 at 3-month follow-up) was achieved in 11 (32.3%) of 34 patients. The mortality rate at 3-month follow-up was 29.4% (10 of 34 patients). Patients treated with the Solitaire stentriever and the ADAPT catheter had a higher recanalization rate (12 [92.3%] of 13 patients vs 5 [23.8%] of 21 patients, p = 0.0002) and a shorter mean (± SD) procedure duration (88 ± 31 minutes vs 126 ± 58 minutes, p = 0.04) than patients treated with older devices. CONCLUSIONS The latest devices have improved the effectiveness of mechanical thrombectomy in acute BAO. Their use in further studies may help demonstrate a benefit in the endovascular management of acute BAO.

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

“…The procedures were also faster with the newer devices (88±31 min vs 126±58 min). 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.…”

A review of the diagnosis and management of vertebral basilar (posterior) circulation disease

“…(1) There were reports of the successful use of stent retrieval systems to remove a basilar artery thrombosis, a subset of the universe of PCD. [ 21 45 53 60 67 83 91 96 110 116 118 122 ]…”

Diagnosis and Management of Acute Ischemic Stroke

“…By comparison, the recanalization rate (Thrombolysis in Cerebral Infarction scale, 2b/3) was higher (92.3% vs 23.8%; P¼.0002) with a shorter mean procedure time (88AE31 minutes vs 126AE58 minutes; P¼.04) using the Solitaire stent retriever and ADAPT technique than in patients treated with older devices. 104 The Australian Urokinase Stroke Trial and other case series explored the use of IAT but were inconclusive about its efficacy. While the IMS III study included mostly ICA and M1 occlusions, only 4 patients with posterior circulation occlusion were enrolled, and there was no difference in outcome between the treatment and control groups.…”