Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke

Bouslama, Mehdi; Haussen, Diogo C; Aghaebrahim, Amin; Grossberg, Jonathan A; Walker, Gregory; Rangaraju, Srikant; Horev, Anat; Frankel, Michael; Nogueira, Raul G; Jovin, Tudor G; Jadhav, Ashutosh P.

doi:10.1161/strokeaha.117.018270

Cited by 117 publications

(119 citation statements)

References 26 publications

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“…Age, stroke severity at admission, and time from symptom onset to groin puncture did not differ between PCS and ACS in their study. Similar to a retrospective case series of 214 patients with PCS from two US academic institutions, a lower NIHSS score at admission and successful recanalization were associated with favourable outcome in our study .…”

Section: Discussionsupporting

confidence: 86%

Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry

Weber

Minnerup

Nordmeyer

et al. 2018

Euro J of Neurology

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Section: Discussionsupporting

confidence: 86%

Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry

Weber

Minnerup

Nordmeyer

et al. 2018

Euro J of Neurology

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…GFR was analyzed as a continuous variable to evaluate the association with outcomes in uni-and multivariate logistic regression analyses and additionally dichotomized into < 60 or ≥60 mL/min/1.73 m 2 . Thrombolysis in cerebral infarction scores were dichotomized into 0-2a and 2b-3 [18]. The difference of GFRs at baseline and at discharge was calculated in each patient, and the one sample t test was used to test for significant changes.…”

Section: Discussionmentioning

confidence: 99%

“…Comparison of our results to former reports is therefore confined. One study that evaluated predictors of good outcome after endovascular therapy for vertebrobasilar stroke observed that higher creatinine levels at admission were associated with poor outcome in univariate analysis [18]. However, this association was no longer present in multivariate testing, and associations between impaired renal function and ICH were not described [18].…”

Section: Discussionmentioning

confidence: 99%

Renal Impairment Is Associated with Intracerebral Hemorrhage after Mechanical Thrombectomy in Vertebrobasilar Stroke

et al. 2019

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Background and Purpose: Renal dysfunction (RD) is overall associated with unfavorable functional outcome and higher risk of mortality after acute ischemic stroke. Associations between RD and outcome in patients with acute vertebrobasilar stroke treated with thrombectomy have not been evaluated so far. Materials and Methods: Consecutive patients with vertebrobasilar stroke treated with mechanical thrombectomy between October 2010 and July 2017 at our center were analyzed. RD was defined as glomerular filtration rate (GFR) < 60 mL/min/1.73 m² at admission. Endpoints were (I) poor clinical outcome (modified Rankin Scale > 2) at 3 months, (II) 3-month mortality, and (III) intracerebral hemorrhage (ICH) after treatment. Results: Overall, 106 patients were included. Median age was 73.0 years (interquartile range 62.0–80.0), and RD was present in 20.8%. Multivariate analysis revealed that RD was associated with a higher risk for any ICH (OR 3.54; 95% CI 1.09–11.49; p = 0.035). Stroke severity at onset predicted poor clinical outcome (OR 1.08; 95% CI 1.03–1.14; p = 0.003). Neither low GFR nor any ICH, but stroke severity (OR 1.08; 95% CI 1.03–1.14; p = 0.002) and poor recanalization results (OR 11.38; 95% CI 2.01–64.41; p = 0.006) were associated with a higher risk for mortality. Conclusions: Patients with RD and acute vertebrobasilar stroke should be thoroughly monitored to prevent ICH after thrombectomy. Our results support performing mechanical thrombectomy in acute stroke patients with large vessel occlusions of the posterior circulation, irrespective of their renal function.

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Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke

Abstract: In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.

Cited by 117 publications

References 26 publications

Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry

Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry

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

Renal Impairment Is Associated with Intracerebral Hemorrhage after Mechanical Thrombectomy in Vertebrobasilar Stroke

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