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Mechanical Thrombectomy in Basilar Artery Occlusion

Presence of Bilateral Posterior Communicating Arteries is a Predictor of Favorable Clinical Outcome

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A Correction to this article was published on 09 January 2018

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Abstract

Background

Mechanical thrombectomy (MT) of basilar artery occlusions (BAO) is a subject of debate. We investigated the clinical outcome of MT in BAO and predictors of a favorable outcome.

Material and Methods

A total of 104 MTs of BAO (carried out between 2010 and 2016) were analyzed. Favorable outcome as a modified Rankin scale (mRS) ≤ 2 at 90 days was the primary endpoint. The influence of the following variables on outcome was investigated: number of detectable posterior communicating arteries (PcoAs), patency of basilar tip, completeness of BAO and posterior circulation Alberta Stroke Program early computed tomography score (PC-ASPECTS). Secondary endpoints were technical periprocedural parameters including symptomatic intracranial hemorrhage (sICH).

Results

The favorable clinical outcome at 90 days was 25% and mortality was 43%. The rate of successful reperfusion, i.e. modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was 82%. Presence of bilateral PcoAs (area under the curve, AUC: 0.81, odds ratio, OR: 4.2, 2.2–8.2; p < 0.0001), lower National Institute of Health Stroke Scale (NIHSS) on admission (AUC: 0.74, OR: 2.6, 1.3–5.2; p < 0.01), PC-ASPECTS ≥ 9 (AUC: 0.72, OR: 4.2, 1.5–11.9; p < 0.01), incomplete BAO (AUC: 0.66, OR: 2.6, 1.4–4.8; p < 0.001), and basilar tip patency (AUC: 0.66, OR: 2.5, 1.3–4.8; p < 0.01) were associated with a favorable outcome. Stepwise logistic regression analysis revealed that the strongest predictors of favorable outcome at 90 days were bilateral PcoAs, low NIHSS on admission, and incomplete BAO (AUC: 0.923, OR: 7.2, 3–17.3; p < 0.0001).

Conclusion

The use of MT for BAO is safe with high rates of successful reperfusion. Aside from baseline NIHSS and incomplete vessel occlusion, both known predictors of favorable outcome in anterior circulation events, we found that collateral flow based on the presence or absence of PcoAs had a decisive prognostic impact.

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Change history

  • 09 January 2018

    <Emphasis Type="Bold">Correction to:</Emphasis>

    <Emphasis Type="Bold">Clin Neuroradiol 2017</Emphasis>

    <ExternalRef><RefSource>https://doi.org/10.1007/s00062-017-0651-3</RefSource><RefTarget Address="10.1007/s00062-017-0651-3" TargetType="DOI"/></ExternalRef>

    The original version of this article unfortunately contained a mistake. The presentation of Fig. 2 was incorrect. The corrected figure is given …

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Authors and Affiliations

  1. Department of Neuroradiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Volker Maus, Alev Kalkan, Christoph Kabbasch, Nuran Abdullayev & Jan Borggrefe

  2. Department of Neurology, University Hospital Cologne, Cologne, Germany

    Henning Stetefeld, Christian Dohmen & Gereon Rudolf Fink

  3. Clearing Unit Ethics, Medical Faculty of Cologne & Research Unit Ethics, Department of Child and Adolescence Psychiatry, University Hospital Cologne, Cologne, Germany

    Utako Birgit Barnikol

  4. Department of Neuroradiology, Charité, Berlin, Germany

    Thomas Liebig

  5. Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany

    Gereon Rudolf Fink

  6. Department of Neuroradiology, University Hospital Aachen, Aachen, Germany

    Anastasios Mpotsaris

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  1. Volker Maus
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  2. Alev Kalkan
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Correspondence to Volker Maus.

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Conflict of interest

V. Maus, A. Kalkan, C. Kabbasch, N. Abdullayev, H. Stetefeld, U.B. Barnikol, T. Liebig, C. Dohmen, G.R. Fink, J. Borggrefe and A. Mpotsaris declare that they have no competing interests.

Ethical standards

The study was approved by the local ethics committee (Registration ID: 16-347) and was conducted in accordance with the Declaration of Helsinki.

Additional information

J. Borggrefe and A. Mpotsaris contributed equally to the manuscript.

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Maus, V., Kalkan, A., Kabbasch, C. et al. Mechanical Thrombectomy in Basilar Artery Occlusion. Clin Neuroradiol 29, 153–160 (2019). https://doi.org/10.1007/s00062-017-0651-3

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