Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation.

Meinel, Thomas Raphael; Kaesmacher, Johannes; Chaloulos-Iakovidis, Panagiotis; Panos, Leonidas; Mordasini, Pasquale; Mosimann, Pascal J; Michel, Patrik; Hajdu, Steven; Ribo, Marc; Requena, Manuel; Maegerlein, Christian; Friedrich, Benjamin; Costalat, V; Benali, Amel; Pierot, Laurent; Gawlitza, Matthias; Schaafsma, Joanna; Pereira, Vitor M; Gralla, Jan and Fischer, Urs (2019). Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. (In Press). Journal of neurointerventional surgery BMJ Publishing Group 10.1136/neurintsurg-2018-014516

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BACKGROUND Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based. OBJECTIVE To compare patients' outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT. METHODS In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms. RESULTS MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 - 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 - 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO. CONCLUSIONS In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR. TRIAL REGISTRATION NUMBER NCT03496064.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Meinel, Thomas Raphael; Kaesmacher, Johannes; Chaloulos-Iakovidis, Panagiotis; Panos, Leonidas; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

05 Aug 2019 10:24

Last Modified:

05 Aug 2019 10:24

Publisher DOI:

10.1136/neurintsurg-2018-014516

PubMed ID:

31239331

Uncontrolled Keywords:

angiography intervention stroke thrombectomy thrombolysis

BORIS DOI:

10.7892/boris.131601

URI:

https://boris.unibe.ch/id/eprint/131601

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