Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

Abstract

5) demonstrated superiority of modern endovascular thrombectomy approaches in patients with acute ischemic stroke from large vessel occlusion when compared Background and Purpose-Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes. Methods-We performed a multicenter retrospective analysis of consecutive patients with posterior circulation strokes, who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique [ADAPT] approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics. Results-A total of 100 patients were included in the final analysis (mean age, 63.5±14.2 years; mean admission National Institutes of Health Stroke Scale score, 19.2±8.2). Favorable clinical outcome at 3 months (modified Rankin Scale score ≤2) was achieved in 35% of patients. Successful recanalization and shorter time from stroke onset to the start of the procedure were significant predictors of favorable clinical outcome at 90 days. Stent retriever and aspiration thrombectomy as primary treatment approaches showed comparable procedural and clinical outcomes. None of the baseline advanced imaging modalities (magnetic resonance imaging, computed tomographic perfusion, or computed tomography angiography assessment of collaterals) showed superiority in selecting patients for thrombectomy. Conclusions-Time

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

“…This finding was inconsistent with some previous studies that described different treatment outcomes between these 2 thrombectomy techniques in patients with acute BAO 7, 23, 24, 25. Gory et al analyzed procedural details in 100 patients with BAO and reported that aspiration thrombectomy was superior to stent‐retriever thrombectomy as the first‐line strategy.…”

“…Similarly, 2 small case series reported that aspiration thrombectomy achieved a higher rate of complete recanalization and a shorter procedure time than stent‐retriever thrombectomy in patients with acute BAO 23, 24. In contrast, Mokin et al found no significant differences in the procedure time, the rate of successful reperfusion, or the rate of good outcomes between the stent‐retriever and aspiration thrombectomy in a cohort of 100 patients with posterior circulation strokes 7. Recently, the ASTER (Contact Aspiration versus Stent Retriever for Successful Revascularization) trial also demonstrated no significant differences between the 2 thrombectomy techniques in the rates of successful and complete reperfusion, embolization to a new vascular territory, and 90‐day mRS 0 to 2, among patients with acute anterior circulation stroke 26.…”

“…The previously identified factors independently associated with a good outcome after endovascular therapy in posterior circulation stroke included a low baseline NIHSS, successful reperfusion, a history of smoking, a high DWI‐Acute Stroke Program Early CT Score (ASPECTS), a shorter time to the start of procedure, a shorter time to reperfusion, better collateral status, and magnetic resonance imaging–based patient selection 3, 7, 9, 18, 19. Recently, Gory et al reported that only the failure to achieve successful reperfusion was an independent predictor of mortality at 3 months, in patients with acute BAO who underwent thrombectomy 20.…”

“…Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke,4 the effectiveness and safety of modern thrombectomy remains uncertain for patients with acute BAO. Although multiple case studies have described endovascular therapy for acute BAO, previous studies are limited by small sample sizes, heterogeneous patient populations, and the use of older generation devices and techniques 3, 5, 6, 7, 8, 9. Moreover, several important issues remain to be elucidated, such as identifying predictors of functional outcome after modern thrombectomy or the selection of a first‐line thrombectomy technique for patients with acute BAO.…”

Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

“…[3][4][5][6] Several studies reported that recanalization should be promptly performed to treat posterior circulation large vessel occlusion (pc-LVO), as indicated for the anterior circulation. 7,8) However, when selecting the transfemoral approach (TFA) for patients in whom an approach to the right vertebral artery (VA) is necessary, a specific interval is sometimes required until reaching due to the tortuosity of the aortic arch. We speculated that the transradial approach (TRA) might be useful in patients in whom an approach to the right VA is necessary, and treated them using the TRA.…”