Thrombectomy for Comatose Patients with Basilar Artery Occlusion

Guenego, Adrien; Lucas, Ludovic; Gory, Benjamin; Richard, Sébastien; Aubertin, Mathilde; Weisenburger‐Lile, David; Labreuche, Julien; Dargazanli, Cyril; Benali, Amel; Bourcier, Romain; Détraz, Lili; Vannier, Stéphane; Guillen, Maud; Eugène, François; Walker, Gregory; Lun, Ronda; Wormsbecker, Andrew; Ducroux, Célina; Piotin, Michel; Blanc, Raphaël; Consoli, Arturo; Lapergue, Bertrand; Fahed, Robert; Investigators, Etis

doi:10.1007/s00062-021-01001-9

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…Most studies have shown that females with AIS achieve poorer outcomes after MT [16, 25]. However, some recent studies show that both males and females with anterior circulation stroke achieve similar functional outcomes [8, 15, 26] and others even show that males achieve poorer outcomes after MT compared to females [27]. The discrepancy in findings might have been due to an inclusion of a disproportionately higher proportion of posterior circulation strokes in the male subgroup in some studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study

Tan¹,

Siow²,

Lee³

et al. 2022

Cerebrovasc Dis

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Introduction: Identifying differences in outcome of basilar artery occlusion (BAO) between males and females may be useful in aiding clinical management. Recent studies have demonstrated widespread underrepresentation of women in acute stroke clinical trials. This international multicentre study aimed to determine sex differences in outcome after mechanical thrombectomy (MT) for patients with acute BAO. Methods: We performed a retrospective analysis of consecutive patients with BAO who had undergone MT in seven stroke centres across five countries (Singapore, Taiwan, United Kingdom, Sweden, and Germany), between 2015 and 2020. Primary outcome was a favourable functional outcome measured by a modified Ranking Scale (mRS) of 0–3 at 90 days. Secondary outcomes were mRS 0–3 upon discharge, mortality, symptomatic intracranial haemorrhage (sICH) and subarachnoid haemorrhage (SAH). Results: Among the 322 patients who underwent MT, 206 (64.0%) patients were male and 116 (36.0%) were female. Females were older than males (mean ± SD 70.9 ± 14.3 years vs. 65.6 ± 133.6 years; p = 0.001) and had higher rates of atrial fibrillation (38.9% vs. 24.2%; p = 0.012). Time from groin puncture to reperfusion was shorter in females than males (mean ± SD 57.2 ± 37.2 min vs. 71.1 ± 50.9 min; p = 0.021). Despite these differences, primary and secondary outcome measures were similar in females and males, with comparable rates of favourable 90-day mRS scores (mean ± SD 46 ± 39.7 vs. 71 ± 34.5; OR = 1.20; 95% confidence interval [CI] = 0.59–2.43; p = 0.611), favourable discharge mRS scores (mean ± SD 39 ± 31.6 vs. 43 ± 25.9; OR = 1.38; 95% CI = 0.69–2.78; p = 0.368) and in-hospital mortality (mean ± SD 30 ± 25.9 vs. 47 ± 22.8; OR = 1.15; 95% CI = 0.55–2.43; p = 0.710. Rates of complications such as sICH (mean ± SD 5 ± 4.3 vs. 9 ± 4.4; OR = 0.46; 95% CI = 0.08–2.66; p = 0.385) and SAH (mean ± SD 4 ± 3.4 vs. 5 ± 2.4; OR = 0.29; 95% CI = 0.03–3.09; p = 0.303) comparably low in both groups. Conclusion: Females achieved comparable functional outcomes compared with males after undergoing MT for BAO acute ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study

Tan¹,

Siow²,

Lee³

et al. 2022

Cerebrovasc Dis

View full text Add to dashboard Cite

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“…Mechanical thrombectomy (MT) is associated with improved functional outcome when performed in patients with ischemic stroke and large vessel occlusion in the anterior circulation [11,20,27]. For patients presenting with an acute occlusion of the basilar artery (BAO), however, evidence is yet spare, although this patient population represents about 20% of all stroke patients [12]. Successful vessel recanalization has been described as the most important predictor of good functional outcome in BAO stroke [7].…”

Section: Introductionmentioning

confidence: 99%

Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

et al. 2022

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Purpose Evidence regarding the effect of mechanical thrombectomy (MT) of basilar artery occlusion (BAO) stroke is yet sparse. As successful recanalization has been suggested as major determinant of outcome, the early identification of modifiable factors associated with successful recanalization could be of importance to improve functional outcome. Hyperglycemia has been associated with enhanced thrombin generation and unfavorably altered clot features. Objective We hypothesized that serum baseline glucose is associated with likelihood of vessel recanalization mediated by collateral quality and clot burden in BAO stroke. Methods BAO stroke patients who received multimodal CT on admission were analyzed. The association of vessel recanalization defined using modified Thrombolysis in cerebral infarction scale (mTICI) scores 2b-3, and baseline imaging and clinical parameters were tested in logistic regression analyses. Collateral quality and clot burden were evaluated using the Basilar Artery on CT-Angiography (BATMAN) score. Results Out of 117 BAO patients, 91 patients (78%) underwent MT. In 70 patients (77%), successful recanalization could be achieved (mTICI 2b/3). In multivariable logistic regression analysis, only a higher BGL (aOR 0.97, 95% CI 0.96–0.99, p = 0.03) and higher BATMAN score (aOR 1.77, 95% CI 1.11–2.82, p = 0.02) were independently associated with vessel recanalization. Application of alteplase, or time from symptom onset-imaging revealed no independent association with recanalization status. Conclusion Higher BGL was significantly associated with reduced likelihood for recanalization success besides BATMAN score as a measure of collateral quality and clot burden. BGL could be tested as a modifiable parameter to increase likelihood for recanalization in BAO stroke, aiming to improve functional outcome.

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“…1,2 For patients with basilar artery occlusion (BAO), evidence is yet sparse, although this population represents approximately 20% of all ischemic strokes. [2][3][4][5][6] Recently, published results of randomized controlled trials suffered from loss of clinical equipoise and failed to prove the superiority of endovascular treatment (EVT) in this population. 7 Nevertheless, BAO is associated with high rates of mortality and poor functional outcome.…”

Section: Introductionmentioning

confidence: 99%

Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion

Broocks

Faizy

Meyer

et al. 2021

International Journal of Stroke

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Background In basilar artery occlusion (BAO) stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment (EVT) is yet poorly studied. Aim This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of EVT on functional outcome in patients with acute BAO. Methods In this multicenter observational study, patients with BAO and admission-CT were analyzed. At baseline, pcASPECTS was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale (mRS) scores 0-2 at day-90). Results 151 patients were included, of which 112 patients (74%) underwent EVT. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% versus 11%; p=0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI:1.25-16.4, p=0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean mRS 5.3, 95%CI:4.9-5.8). Conclusion PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission-CT. These results should be validated to improve patient selection for EVT in BAO, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.

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Thrombectomy for Comatose Patients with Basilar Artery Occlusion

Cited by 14 publications

References 33 publications

Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study

Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study

Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion

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