Treatment of Acute Vertebrobasilar Occlusion Using Thrombectomy with Stent Retrievers: Initial Experience with 18 Patients

Abstract

BACKGROUND AND PURPOSE:Acute vertebrobasilar occlusion is an ominous disease with few proved effective treatments. Experience with stent retrievers is scarce and limited to combined therapies (stent retrievers associated with previous intravenous fibrinolysis, intra-arterial thrombolysis, or other mechanical devices). We present our experience with 18 patients treated with direct thrombectomy by using stent retrievers.

Acute Basilar Artery Occlusion: Outcome of Mechanical Thrombectomy with Solitaire Stent within 8 Hours of Stroke Onset

“…Recent studies with the use of mechanical thrombectomy with stent retrievers reported significantly increased recanalization rates ranging from 74 -100% in patients with acute BAO. [12][13][14] In our study, we achieved successful recanalization (TICI grades 2b to 3) in 96% (24/25) of patients, which is in line with previous reports. Successful recanalization with only the Solitaire stent occurred in 84% (21/25) of patients.…”

“…[12][13][14] In contrast to our study, these previous studies included patients treated within 24 hours of stroke symptom onset. In a series of 14 patients treated with a Solitaire thrombectomy, Mordasini et al 12 reported that 28.6% (4/14) had a good outcome (mRS 0 -2), and the mortality rate was 35.7% (5/14).…”

“…In their study, a Solitaire thrombectomy was not the first-line endovascular treatment, and the median time from symptom onset to first angiogram was 414 minutes (range, 176 -1440 minutes). Espinosa et al 13 reported a series of 18 patients with acute BAO who were directly treated with mechanical thrombectomy with either the Solitaire stent (n ϭ 10) or the Trevo stent (n ϭ 8). In their study, good functional outcome (mRS 0 -2) was achieved in 50% (9/18), the mortality rate was 22.3% at 3 months, and time from symptom onset to groin puncture was 366 minutes.…”

“…The efficacy of stent retrievers for treating acute BAO was reported in several recent case series. [12][13][14] These previous studies used a longer time window of up to 24 hours for mechanical thrombectomy in patients with acute BAO. However, BASICS showed that early recanalization therapy in patients with acute BAO is associated with a more favorable outcome, and all patients with severe stroke treated Ͼ9 hours after symptom onset had poor functional outcome despite IV or IA thrombolysis.…”

Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device

“…3 Early recanalization remains the main important factor that can improve outcome. [4][5][6] However, even though the best recanalization rate is achieved by using a newer stent retriever, such as a Solitaire FR Device (Covidien, Irvine, California) (up to 100%), [7][8][9][10] stent retriever impact on functional outcome is not as clear-cut as expected and has not been documented in a randomized trial. The extent of baseline brain stem ischemic damage can also influence outcome.…”