Abstract Number ‐ 6: Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Abstract

Introduction Two recent trials demonstrated a benefit for endovascular thrombectomy (EVT) in the treatment of basilar artery occlusion (BAO). Considering the expected increase in the utilization of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists currently performing EVT for BAO. Methods We conducted an international online survey of physician opinions on the use of EVT in BAO between January to March 2022. The survey was distributed through stroke and neurointerventional organizations. Survey questions examined selection of patients for the procedure and the techniques currently used for EVT in BAO. Results More than 3,000 participants were invited yielding 1,245 respondents, of which 543 were classified as neurointerventionalists across 52 countries and included in this analysis. Most neurointerventionalists would proceed to EVT for occlusions of the V4 segment, the basilar artery, or the PCA, without regard for prior IVT. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method with 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease (ICAD) etiology, combined stent retriever and aspiration thrombectomy was the preferred method with 40.5% of neurointerventionalists (Figure 1). The majority of neurointerventionalists (88.0%) would proceed to stenting after three or fewer failed passes for patients with BAO of ICAD etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%). Conclusions Amongst the surveyed neurointerventionalists, the most common techniques for EVT of patients with BAO were contact aspiration or combined stent retriever with aspiration thrombectomy. For patients with BAO due to ICAD, the majority of neurointerventionalists were willing to stent and do so most often after three or fewer failed passes and with the use of dual antiplatelet medications. Further study is needed to determine the optimal technique for EVT of BAO with or without ICAD.

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

“…Subgroups of interest are those who may be at higher risk of intracranial hemorrhage, such as those with large core infarction, 97 and large artery atherosclerotic disease, wherein acute carotid or intracranial stenting may be necessary with adjuvant antiplatelet therapy. 98 99 100 101 102 Intracranial atherosclerotic–related LVO is another current gap in knowledge, 103 104 105 and is covered separately in this issue. 103 While there is no randomized trial evidence to support EVT in patients presenting beyond 24 hours, it is likely that criteria for eligibility of patients based on small ischemic core or a good CT ASPECTS in the late 6- to 24-hour window applies to this group of patients as had been shown by cohort studies.…”

What Is the Evidence for Endovascular Thrombectomy in Posterior Circulation Stroke?

“…In the After the BEST of BASICS (ABBA) survey of 543 interventionists across 52 countries, contact aspiration was the preferred method for embolic etiology in 50.3% of respondents, whereas combined stent-retriever and aspiration was preferred for intracranial atherosclerotic occlusion in 40.5%. 96 When it comes to adjunctive antithrombotic therapy in BAO, not much data to guide the treatment are available. An observational study compared tirofiban and oral antiplatelet therapy to oral antiplatelets in patients undergoing EVT for vertebrobasilar occlusion and found no difference in functional outcome or mortality despite better recanalization rates.…”

“…97 In acute intracranial stenting for BAO, aspirin and clopidogrel were the most common antiplatelet regime (52.4%) in the ABBA survey. 96…”