Thrombectomy for Basilar Artery Occlusion with Mild Symptoms

Guenego, Adrien; Dargazanli, Cyril; Weisenburger‐Lile, David; Gory, Benjamin; Richard, Sébastien; Ducroux, Célina; Piotin, Michel; Blanc, Raphaël; Labreuche, Julien; Lucas, Ludovic; Aubertin, Mathilde; Benali, Amel; Bourcier, Romain; Détraz, Lili; Vannier, Stéphane; Guillen, Maud; Eugène, François; Walker, Gregory; Lun, Ronda; Consoli, Arturo; Lapergue, Bertrand; Fahed, Robert; Redjem, Hocine; Escalard, Simon; Desilles, Jean‐Philippe; Cicciò, Gabriele; Smajda, Stanislas; Maïer, Benjamin; Hébert, Solène; Delvoye, François; Mazighi, Mikaël; Obadia, Mikael; Sabben, Candice; Peres, Roxanne; Corabianu, Ovide; Broucker, T. de; Smadja, Didier; Alamowitch, Sonia; Ille, Olivier; Manchon, Éric; Garcia, Pierre‐Yves; Taylor, Guillaume; Maacha, Malek Ben; Wang, Adrien; Évrard, Serge; Tchikviladzé, Maya; Ajili, Nadia; Weisenburger, David; Gorza, Lucas; Buard, Géraldine; Coskun, Oguzhan; Maria, Federico Di; Rodesh, Georges; Sergio, Zimatore; Leguen, Morgan; Gratieux, Julie; Pico, Fernando; Rakotoharinandrasana, Haja; Tassan, Philippe; Poll, Roxanna; Marinier, S; Marnat, Gaultier; Gariel, Florent; Barreau, Xavier; Berge, Jérôme; Louis, Veunac; Menegon, Patrice; Sibon, Igor; Olindo, Stéphane; Renou, Pauline; Sagnier, Sharmila; Poli, Mathilde; Debruxelles, Sabrina; Daumas‐Duport, Benjamin; Pawlik, Alexandre; Roy, Monica; Lenoble, Cédric; L’Allinec, Vincent; Girot, Jean‐Baptiste; Desal, Hubert; Bracard, Serge; Anxionnat, René; Braun, Marc; Derelle, Anne‐Laure; Tonnelet, Romain; Liao, Liang; Zhu, François; Schmitt, Emmanuelle; Planel, Sophie; Humbertjean, Lisa; Gioia, Mione; Lacour, Jean‐Christophe; Bonnerot, Mathieu; Riou‐Comte, Nolwenn; Costalat, Vincent; Arquizan, Caroline; Gascou, Grégory; Lefèvre, Pierre‐Henri; Derraz, Imad; Riquelme, Carlos; Gaillard, Nicolas; Mourand, Isabelle; Corti, L.; François, Ετιεννε; Ferré, Jean-Christophe; Raoult, Hélène; Ronzière, Thomas; Lassale, Maria; Paya, Christophe; Gauvrit, Jean‐Yves; Tracol, Clément; Langnier-Lemercier, Sophie

doi:10.1016/j.wneu.2021.02.010

Cited by 10 publications

(17 citation statements)

References 24 publications

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“…In our study, 37 patients (59%) with pc-LVO and baseline NIHSS score ≤ 10 had a good clinical outcome after MT, whereas it was poor in the remaining 41%. These results are in line with those of Guenego et al, which reported a poor outcome at 3 months in more than 30% of patients despite mild initial symptoms and a successful endovascular recanalization [5].…”

Section: Discussionsupporting

confidence: 92%

“…Management of patients with ischemic stroke due to pc-LVO and mild neurological symptoms represents one of the most complex scenario because of its unpredictable outcome. Indeed, some of these patients may spontaneously recanalize while others will deteriorate [5]. In addition, the NIHSS score does not accurately assess the severity of the stroke in the vertebrobasilar territory [12].…”

Section: Discussionmentioning

confidence: 99%

“…Several NIHSS cut-off values have been previously used to define a condition of mild neurological deterioration in patients with pc-LVO, that are usually higher than the threshold established for stroke due to anterior circulation LVO [5,6]. Indeed, a baseline NIHSS ≤ 10 has been set as the threshold for identifying patients with low/moderate neurological symptoms in previous studies [7].…”

Section: Introductionmentioning

confidence: 99%

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Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

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Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0–0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0–0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33–16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16–3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

Life

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“…The previously identified factors independently associated with a good outcome after EVT in posterior circulation stroke included decreased baseline NIHSS score, shorter time to recanalization, increased pc-ASPECTS, shorter time to therapy, absence of prodromal minor stroke, better collateral status, and absence of hyperlipidemia. 13,25 Patients with ABAO and mild to moderate stroke had better posterior circulation collateral and better outcomes after MT than patients with severe stroke in a 2021 study. 14 Moreover, younger age, decreased NIHSS score, lack of diabetes, and lack of cerebral hemorrhage were associated with better outcomes in a 2018 study.…”

Section: Evt Group Smt Groupmentioning

confidence: 99%

“… 14 Although MT has a high rate of recanalization, a significant proportion (approximately 32%) of patients with mild ABAO had a poor long-term clinical outcome. 13 Interestingly, Wang et al 6 found that EVT was associated with effective restoration of cerebral blood flow and decreased incidence of complications among patients with ABAO and severe symptoms. This finding suggests that clinical severity at admission may be associated with neurological outcomes after EVT.…”

Section: Introductionmentioning

confidence: 99%

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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Predictors of Good Clinical Outcome after Thrombectomy for Distal Medium Vessel Occlusions

et al. 2022

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Thrombectomy for Basilar Artery Occlusion with Mild Symptoms

Cited by 10 publications

References 24 publications

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

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

Predictors of Good Clinical Outcome after Thrombectomy for Distal Medium Vessel Occlusions

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