Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review

Gory, Benjamin; Eldesouky, Islam; Sivan-Hoffmann, Rotem; Rabilloud, M.; Ong, Elodie; Riva, Roberto; Gherasim, Dorin Nicolae; Turjman, Alexis; Nighoghossian, Norbert; Turjman, Francis

doi:10.1136/jnnp-2014-310250

Cited by 157 publications

(176 citation statements)

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“…The rate of symptomatic hemorrhage was only 1.9% in the present study, which was much lower than the 4.4% reported in the HERMES study16 and the 4% reported in the meta‐analysis by Gory et al 5. We also found a low mortality (16%) compared with the pooled estimate rate of 30% in the previous meta‐analysis 5. However, our mortality rate was comparable to that reported in a study on anterior circulation stroke (15.3% in the HERMES study) 16.…”

Section: Discussioncontrasting

confidence: 80%

“…All 212 patients included were primarily treated with either stent‐retriever thrombectomy (68%) or contact aspiration thrombectomy (32%) within 12 hours of symptom onset. The rate of successful reperfusion (92%) in this study was much higher than the 71% reported in the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke) trials16 and the pooled 81% (95% CI, 73%–87%) reported in a meta‐analysis by Gory et al, which included 15 studies on the stent‐retriever thrombectomy in patients with acute BAO 5. The high rate of successful reperfusion we observed might be partly because of the extensive experience of the interventionists at high‐volume comprehensive stroke centers.…”

Section: Discussioncontrasting

confidence: 54%

“…This result was also consistent with the previous meta‐analysis by Gory et al. They found a good clinical outcome (mRS 0–2 at 90 days) in 42% of patients 5. Taken together, these findings suggested that modern thrombectomy might be considered the standard of care for eligible patients with acute BAO, despite the lack of a published randomized controlled trial to date 5, 8…”

Section: Discussionmentioning

confidence: 98%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Kang

Jung

Yoon

et al. 2018

JAHA

123

117

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BackgroundDespite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.Methods and ResultsThis study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique.ConclusionsEndovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

Kang

Jung

Yoon

et al. 2018

JAHA

123

117

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“…[3][4][5][6][7]11 Eligible patients are adults 18 years of age or older (no upper age limit) with acute ischemic stroke caused by thromboembolic occlusion of a proximal intracranial artery in either the anterior or posterior circulation (e.g., internal carotid artery terminus, middle cerebral artery [M1 or M2 segment] and basilar trunk).…”

Section: Who Is Eligible?mentioning

confidence: 99%

Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique

Patro

Iancu

2017

CMAJ

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Outcomes of Endovascular Therapy in Acute Basilar Artery Occlusion With Severe Symptoms

et al. 2021

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IMPORTANCEEndovascular therapy (EVT) has been reported to be safe and effective in improving clinical outcomes among patients with acute basilar artery occlusion (ABAO). The benefits associated with EVT remain uncertain for patients with ABAO with severe symptoms (ie, National Institutes of Health Stroke Scale [NIHSS] score Ն 21). OBJECTIVES To assess the outcomes associated with EVT and identify factors associated with outcomes among patients with ABAO and severe symptoms. DESIGN, SETTING, AND PARTICIPANTS This prospective, nationwide cohort study was conducted using data from January 2014 to May 2019 in China from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry (BASILAR). Included patients had ABAO and underwent EVT or standard medical treatment (SMT) alone in routine clinical practice. Patients were dichotomized into severe symptoms (ie, NIHSS score Ն 21) and minor to moderate symptoms (NIHSS score < 21) groups. Patients were followed up for 90 days. Data were analyzed from December 2020 through June 2021.EXPOSURES EVT with SMT vs SMT alone. MAIN OUTCOMES AND MEASURES The primary outcome was improvement in modified RankinScale (mRS) score at 90 days, defined as a decrease by 1 grade in mRS score. Secondary outcomes included favorable functional outcome (ie, mRS score, 0-3) and mortality. RESULTS Among 542 patients with ABAO and severe symptoms (median [IQR] age,[65][66][67][68][69][70][71][72][73][74] years; 147 [27.1%] women), 431 patients (79.5%) received EVT and 111 patients (20.5%) received SMT.

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Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review

Cited by 157 publications

References 39 publications

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

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

Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique

Outcomes of Endovascular Therapy in Acute Basilar Artery Occlusion With Severe Symptoms

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