Reinier C van Houwelingen1, Gert-Jan Luijckx1, Aryan Mazuri2, Reinoud P H Bokkers2, Omid S Eshghi2, Maarten Uyttenboogaart3. 1. Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 2. Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 3. Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands2Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Abstract
IMPORTANCE: After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO). OBJECTIVE: To report up-to-date outcome data of intra-arterial (IA) treatment in patients with BAO and to evaluate the influence of collateral circulation on outcome. DESIGN, SETTING, AND PARTICIPANTS: Single-center retrospective case series of 38 consecutive patients with BAO who underwent IA treatment between 2006 and 2015 at a comprehensive stroke center. EXPOSURES: Intra-arterial treatment by mechanical thrombectomy and/or IA thrombolysis. MAIN OUTCOMES AND MEASURES: Adequate recanalization was defined as a score of 2b or 3 on the Thrombolysis in Cerebral Infarction score. Favorable outcome was defined as a modified Rankin Scale of 0 to 3 at first follow-up. Imaging data on the patency of the vertebral arteries and posterior communicating arteries, as well as the presence of cerebellar arterial anastomosis, were recorded and posttreatment imaging results were reviewed. RESULTS: Of the 38 patients with BAO, mean (SD) age was 58 (16) years, and 21 (55%) were male. Twenty-seven patients (71%) were treated with intravenous thrombolysis before IA therapy. Mechanical thrombectomy was applied to 30 patients, and 7 patients received local urokinase without thrombectomy. The median National Institutes of Health Stroke Scale score was 21 (interquartile range [IQR], 15-32) points, and median time to IA treatment was 288 (IQR, 216-380) minutes. Adequate recanalization was achieved in 34 of 38 cases (89%). Functional outcome was favorable in 19 (50%) patients. No association between patent collateral circulation and favorable outcome was found. Symptomatic intracranial hemorrhage occurred in 2 patients (5%). CONCLUSIONS AND RELEVANCE: The proportion of patients reaching a favorable outcome in our study is comparable to the IA-treated group of the MR CLEAN trial and better than the results reported in the BASICS registry, suggesting that IA intervention in patients with BAO is an effective and safe treatment modality in daily clinical practice.
IMPORTANCE: After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO). OBJECTIVE: To report up-to-date outcome data of intra-arterial (IA) treatment in patients with BAO and to evaluate the influence of collateral circulation on outcome. DESIGN, SETTING, AND PARTICIPANTS: Single-center retrospective case series of 38 consecutive patients with BAO who underwent IA treatment between 2006 and 2015 at a comprehensive stroke center. EXPOSURES: Intra-arterial treatment by mechanical thrombectomy and/or IA thrombolysis. MAIN OUTCOMES AND MEASURES: Adequate recanalization was defined as a score of 2b or 3 on the Thrombolysis in Cerebral Infarction score. Favorable outcome was defined as a modified Rankin Scale of 0 to 3 at first follow-up. Imaging data on the patency of the vertebral arteries and posterior communicating arteries, as well as the presence of cerebellar arterial anastomosis, were recorded and posttreatment imaging results were reviewed. RESULTS: Of the 38 patients with BAO, mean (SD) age was 58 (16) years, and 21 (55%) were male. Twenty-seven patients (71%) were treated with intravenous thrombolysis before IA therapy. Mechanical thrombectomy was applied to 30 patients, and 7 patients received local urokinase without thrombectomy. The median National Institutes of Health Stroke Scale score was 21 (interquartile range [IQR], 15-32) points, and median time to IA treatment was 288 (IQR, 216-380) minutes. Adequate recanalization was achieved in 34 of 38 cases (89%). Functional outcome was favorable in 19 (50%) patients. No association between patent collateral circulation and favorable outcome was found. Symptomatic intracranial hemorrhage occurred in 2 patients (5%). CONCLUSIONS AND RELEVANCE: The proportion of patients reaching a favorable outcome in our study is comparable to the IA-treated group of the MR CLEAN trial and better than the results reported in the BASICS registry, suggesting that IA intervention in patients with BAO is an effective and safe treatment modality in daily clinical practice.
Authors: James I Ausman; David S Liebeskind; Nestor Gonzalez; Jeffrey Saver; Neil Martin; J Pablo Villablanca; Paul Vespa; Gary Duckwiler; Reza Jahan; Tianyi Niu; Noriko Salamon; Bryan Yoo; Satoshi Tateshima; Manuel M Buitrago Blanco; Sidney Starkman Journal: Surg Neurol Int Date: 2018-05-24