Basilar Artery Occlusion Treated with Mechanical Thrombectomy beyond Eight Hours with Successful Recanalization and Good Functional Outcomes

Noufal, Mazen; Schmidley, James W.; Eren, Erdem; Keyrouz, Salah

doi:10.1159/000218072

Cited by 12 publications

(18 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Likewise, Schulte-Altenbourge et al 19 found that neither the duration of brain stem stroke symptoms nor the coma duration was an independent variable for a favorable neurological outcome (mRS score 0–2). Noufal et al 26 described several patients presenting >8 h after symptom onset with poor clinical predictors including depressed levels of consciousness who had good outcomes following mechanical thrombectomy 26. Importantly, these patients did not show evidence of extensive brain stem infarction on diffusion-weighted imaging (DWI).…”

Section: Factors Impacting On Outcome In Patients Treated With Iatmentioning

confidence: 99%

Endovascular therapy for acute basilar artery occlusion: a review of the literature

Mortimer

Bradley

Renowden

2011

J NeuroIntervent Surg

View full text Add to dashboard Cite

Basilar artery occlusion is an infrequent form of acute stroke; clinical outcomes are heterogeneous, but the condition can be fatal. There is a lack of randomized controlled trial data in this field. Case series suggest that patients who are recanalized have much better outcomes than those who are not, and it is generally accepted that intra-arterial techniques achieve high rates of recanalization. Controversially, several studies, including a meta-analysis and registry-based investigation, that have compared intravenous thrombolysis (IVT) and intra-arterial treatment suggest similar outcomes. However, there are many potential sources of bias in each of these studies, precluding a firm conclusion. Indeed, there are many confounding factors that can influence the outcome including severity of presentation, site of occlusion, clot load, degree of collateral flow, timing of therapy, agent used for recanalization and dose of thrombolytic agent. Additionally, pretreatment infarct core imaging using diffusion-weighted imaging and the posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) scoring systems have been shown to predict outcome and therefore may be useful in selecting patients for aggressive therapy. Protocols combining intravenous agents such as glycoprotein IIb/IIIa receptor antagonists or thombolytics agents with intra-arterial techniques ('bridging' therapy) have shown encouraging improvements in neurological outcome and survival. Furthermore, initial case series describing the use of mechanical clot extraction devices or aspiration catheters suggest high rates of recanalization. What would be useful is a randomized trial comparing IVT, endovascular approaches and a combined IVT/endovascular approach. However, the small numbers of patients and multiple confounding factors are barriers to the development of such a trial.

show abstract

Section: Factors Impacting On Outcome In Patients Treated With Iatmentioning

confidence: 99%

Endovascular therapy for acute basilar artery occlusion: a review of the literature

Mortimer

Bradley

Renowden

2011

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…4 We aimed to study the relationship between time to recanalization therapy and functional outcome in patients with acute BAO who participated in the Basilar Artery International Cooperation Study (BASICS).…”

mentioning

confidence: 99%

Time is Brain(stem) in Basilar Artery Occlusion

Vergouwen¹,

Algra²,

Pfefferkorn³

et al. 2012

Stroke

116

View full text Add to dashboard Cite

Background and Purpose-The frequent use of a longer time window for recanalization therapy in patients with basilar artery occlusion (BAO) in daily practice is not supported by any scientific evidence. We investigated the relationship between time to recanalization therapy and functional outcome in BAO with data from the Basilar Artery International Cooperation Study (BASICS). Methods-BASICS is a prospective multicenter registry of patients (n=619) with radiologically confirmed BAO. We analyzed patients receiving intravenous thrombolysis or intra-arterial treatment. Patients were divided into 4 groups based on the interval between estimated time of BAO and start of recanalization therapy: ≤3 hours (n=134), >3 to ≤6 hours (n=151), >6 to ≤9 hours (n=56), and >9 hours (n=68). Primary outcome measure was poor functional outcome (modified Rankin scale score 4-6) after 1 month. We calculated adjusted risk ratios with 95% CIs using Poisson regression analyses with the ≤3 hours group as the reference group. Results-Patients

show abstract

“…Case reports suggest that patients with BAO can recover from recanalization therapy beyond 8 h after symptom onset. [10] Many different methods have been employed to recanalize a large vessel occlusion resulting in AIS. Several studies have demonstrated the efficacy of a combined intravenous and endovascular approach in the treatment of AIS compared with intravenous therapy alone.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of mechanical thrombectomy with Solitaire in patients with acute ischemic stroke

Narayana¹,

Pati²,

Dalai³

2017

IJNS

View full text Add to dashboard Cite

Background Stroke is the third most common cause of death. Ischemic stroke accounts for 87% of all strokes. The standard treatment for acute ischemic stroke (AIS) is IV recombinant tissue plasminogen activator for patients who can reach the hospital with in 4.5 h. A rapid and complete recanalization is a major factor in good clinical outcomes in the treatment of acute cerebral ischemia. Stent-based recanalization techniques are increasingly used in stroke caused by large vessel occlusion, with promising results. Objective To evaluate the safety and efficacy of Solitaire stent retriever in recanalizing cerebral vessels in patients with AIS. Materials and Methods We treated 16 patients of AIS with a mean age of 52.25 years, ranging from 16 to 76 years with Solitaire clot retrieval system from September 2011 to March 2013 at our stroke center. The anterior circulation strokes were treated within 6 h of stroke onset and the posterior circulation strokes were treated up to 24 h of stroke onset. Patients with intracerebral bleed and established large acute infarcts were excluded. Results Out of the 16 patients of AIS treated with Solitaire clot retrieval system, good recanalization (thrombolysis in cerebral infarction 2 [TICI 2] and TICI 3) was achieved in 14/16 patients (87.5%) and no recanalization achieved in 2/16 (12.5%) patients. Clinical outcome was good (modified Rankin score 2 or less) in 10 out of 16 patients (62.5%). Conclusion Mechanical clot retrieval with Solitaire appears to be safe and effective in acutely occluded large intracranial vessels.

show abstract

Basilar Artery Occlusion Treated with Mechanical Thrombectomy beyond Eight Hours with Successful Recanalization and Good Functional Outcomes

Cited by 12 publications

References 13 publications

Endovascular therapy for acute basilar artery occlusion: a review of the literature

Endovascular therapy for acute basilar artery occlusion: a review of the literature

Time is Brain(stem) in Basilar Artery Occlusion

Safety and efficacy of mechanical thrombectomy with Solitaire in patients with acute ischemic stroke

Contact Info

Product

Resources

About