Abstract
Purpose
To describe the clinical and radiological characteristics, frequency, technical aspects and outcome of endovascular treatment of acute basilar artery occlusion (ABO) in the setting of vertebrobasilar steno-occlusive disease.
Methods
Retrospective analysis of databases of two universitary stroke centers including all consecutive patients from January 2013 until May 2017 undergoing thrombectomy for a) acute stroke due to basilar artery occlusion and either significant basilar artery stenosis or vertebral artery stenosis/occlusion as well as b) presumed embolic basilar artery occlusions. Demographics, stroke characteristics, time metrics, recanalization results and outcome were recorded. Interventional strategies were evaluated concerning the thrombectomy technique, additional angioplasty, type of approach with respect to lesion pattern (ipsilateral to steno-occlusive VA lesion: dirty road or contralateral: clean road) and sequence of actions.
Results
Out of 157 patients treated for ABO 38 (24.2%) had associated significant vertebrobasilar steno-occlusive lesions. An underlying significant basilar artery stenosis was present in 23.7% and additionally significant steno-occlusive vertebral lesions were present in 81.5%. Thrombectomy was performed with primary aspiration in 15.8% and with stent-retrievers in 84.2%. Successful revascularization (TICI 2b-3) was achieved in 86.8%. In 52.6% additional stent angioplasty was performed, in 7.9% balloon angioplasty only. The clean road approach was used in 22.5% of cases, the dirty road in 77.4%. Final modified Rankin scale (mRS) was 0–2 in 6 patients (15.8%) and 3–5 in 32 (84.2%). The in-hospital mortality was 36.8%. There were no statistically significant differences in outcome compared to presumed cases of embolisms.
Conclusion
Endovascular treatment of ABO with underlying significant vertebrobasilar steno-occlusive lesions is effective and reasonably safe. Specific procedural strategies apply depending on individual patient pathology and anatomy. Although high rates of recanalization can be achieved, outcomes tend to be poor.
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References
Qureshi AI, Ziai WC, Yahia AM, Mohammad Y, Sen S, Agarwal P, Zaidat OO, Suarez JI, Wityk RJ. Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study. Neurosurgery. 2003;52:1033–9.
Prognosis of patients with symptomatic vertebral or basilar artery stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Stroke. 1998;29:1389–92.
Labauge R, Pages M, Marty-Double C, Blard JM, Boukobza M, Salvaing P. Occlusion of the basilar artery: a review with 17 personal cases (author’s transl). Rev Neurol (Paris). 1981;137:545–71.
Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10:1002–14.
Cohen JE, Leker RR, Gomori JM, Eichel R, Rajz G, Moscovici S, Itshayek E. Emergent revascularization of acute tandem vertebrobasilar occlusions: endovascular approaches and technical considerations-confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke. J Clin Neurosci. 2016;34:70–6.
Behme D, Weber W, Mpotsaris A. Acute basilar artery occlusion with underlying high-grade basilar artery stenosis: multimodal endovascular therapy in a series of seven patients. Clin Neuroradiol. 2015;25:267–74.
Lee YY, Yoon W, Kim SK, Baek BH, Kim GS, Kim JT, Park MS. Acute basilar artery occlusion: differences in characteristics and outcomes after endovascular therapy between patients with and without underlying severe atherosclerotic stenosis. AJNR Am J Neuroradiol. 2017;38:1600–4.
Gao F, Lo WT, Sun X, Mo DP, Ma N, Miao ZR. Combined use of mechanical thrombectomy with angioplasty and stenting for acute basilar occlusions with underlying severe intracranial vertebrobasilar stenosis: preliminary experience from a single Chinese center. AJNR Am J Neuroradiol. 2015;36:1947–52.
Kim YW, Hong JM, Park DG, Choi JW, Kang DH, Kim YS, Zaidat OO, Demchuk AM, Hwang YH, Lee JS. Effect of intracranial atherosclerotic disease on endovascular treatment for patients with acute vertebrobasilar occlusion. AJNR Am J Neuroradiol. 2016; 37:2072–8.
Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J, Alfke K, Jansen O, Zeumer H. Aggressive therapy with intravenous Abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion. Combined local fibrinolysis and intravenous Abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke. 2005;36:1160–5.
Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O’Reilly C, Barber PA, Sharma P, Goyal M, Gahn G, von Kummer R, Demchuk AM. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke. 2008;39:2485–90.
Mordasini P, Brekenfeld C, Byrne JV, Fischer U, Arnold M, Heldner MR, Lüdi R, Mattle HP, Schroth G, Gralla J. Technical feasibility and application of mechanical thrombectomy with the Solitaire FR Revascularization Device in acute basilar artery occlusion. AJNR Am J Neuroradiol. 2013;34:159–63.
Ecker RD, Tsujiura CA, Baker CB, Cushing D. Endovascular reconstruction of vertebral artery occlusion prior to basilar thrombectomy in a series of six patients presenting with acute symptomatic basilar thrombosis. J Neurointerv Surg. 2014;6:379–83.
Markus HS, Larsson SC, Kuker W, Schulz UG, Ford I, Rothwell PM, Clifton A, Investigators VIST. Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischaemia Stenting Trial. Neurology. 2017;89:1229–36.
Antoniou GA, Murray D, Georgiadis GS, Antoniou SA, Schiro A, Serracino-Inglott F, Smyth JV. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg. 2012;55:1167–77.
Compter A, van der Worp HB, Schonewille WJ, Vos JA, Boiten J, Nederkoorn PJ, Uyttenboogaart M, Lo RT, Algra A, Kappelle LJ, VAST investigators. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol. 2015;14:606–14.
Kocak B, Korkmazer B, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of extracranial vertebral artery stenosis. World J Radiol. 2012;4:391–400.
Lockau H, Liebig T, Henning T, Neuschmelting V, Stetefeld H, Kabbasch C, Dorn F. Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology. 2015;57:589–98.
Eckert B, Kucinski T, Pfeiffer G, Groden C, Zeumer H. Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. Cerebrovasc Dis. 2002;14:42–50.
Singer OC, Berkefeld J, Nolte CH, Bohner G, Haring HP, Trenkler J, Gröschel K, Müller-Forell W, Niederkorn K, Deutschmann H, Neumann-Haefelin T, Hohmann C, Bussmeyer M, Mpotsaris A, Stoll A, Bormann A, Brenck J, Schlamann MU, Jander S, Turowski B, Petzold GC, Urbach H, Liebeskind DS, ENDOSTROKE Study Group.. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol. 2015;77:415–24.
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E. Siebert, G. Bohner, S. Zweynert, V. Maus, A. Mpotsaris, T. Liebig and C. Kabbasch declare that they have no competing interests.
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The study was approved by the institutional ethics committee in Berlin. According to the guidelines of the local ethics committee in Cologne, no approval was necessary for conducting this retrospective, observational study.
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Siebert, E., Bohner, G., Zweynert, S. et al. Revascularization Techniques for Acute Basilar Artery Occlusion. Clin Neuroradiol 29, 435–443 (2019). https://doi.org/10.1007/s00062-018-0683-3
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DOI: https://doi.org/10.1007/s00062-018-0683-3