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Recanalization is the Key for Better Outcome of Thrombectomy in Basilar Artery Occlusion

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Abstract

Purpose

Patients with basilar artery occlusion (BAO) were excluded from previous randomized controlled trials (RCTs) of endovascular treatment (ET) for acute ischemic stroke, but are commonly treated in clinical practice. This study aimed at analyzing predictors of functional outcome of ET in patients with BAO to improve patient selection for ET.

Methods

Consecutive patients with BAO who received ET over a 2-year time period were prospectively studied. Baseline characteristics, procedural and outcome data were evaluated. Outcome was assessed by the modified Rankin Scale (mRS) 90 days after stroke. Multivariate regression analyses were performed to identify predictors of outcome across the range of the mRS, of poor outcome (mRS 5–6) and independent outcome (mRS 0–2).

Results

A total of 39 patients with BAO (median age: 75 years, 67% male) were included. Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 24. Intravenous thrombolysis therapy (IVT) was administered in 56%. Successful recanalization assessed by a modified thrombolysis in cerebral infarction (TICI) score ≥2b was achieved in 82%. Independent outcome was observed in 30% of patients with successful recanalization, but in no patient with failed recanalization. Poor outcome was observed in 47% and 86%, respectively. Successful recanalization was associated with lower scores on the mRS at 90 days (p = 0.035), and failed recanalization was associated with an odds ratio of 13.6 for poor outcome (p = 0.036).

Conclusion

Reperfusion is the major predictor of functional outcome in BAO in clinical practice. Failed recanalization resulted in a 13-fold increase of the risk of poor outcome. Successful recanalization is crucial to achieve a better functional outcome in BAO.

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Acknowledgements

We thank Kirsten Jaramillo, Hannes Appelbohm and Dagmar Otto for their support in data acquisition.

Author information

Authors and Affiliations

  1. Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Milani Deb-Chatterji, Anna Alegiani, Christian Gerloff & Götz Thomalla

  2. Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany

    Fabian Flottmann, Hannes Leischner, Caspar Brekenfeld & Jens Fiehler

Authors
  1. Milani Deb-Chatterji
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  2. Fabian Flottmann
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  3. Hannes Leischner
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  4. Anna Alegiani
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  6. Jens Fiehler
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  7. Christian Gerloff
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  8. Götz Thomalla
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Corresponding author

Correspondence to Milani Deb-Chatterji.

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Conflict of interest

M. Deb-Chatterji, F. Flottmann, H. Leischner and C. Brekenfeld declare that they have no competing interests. A. Alegiani reports fees as speaker from Bayer Vital. J. Fiehler reports personal fees from Cerenovus, Penumbra, Route 92 Medical, grants and personal fees from Acandis, Medtronic, Microvention. C. Gerloff reports fees as speaker and/or scientific advisory board member from Actitor Biotech, Amgen, Bayer Healthcare, Boehringer Ingelheim, Prediction Biosciences, Sanofi Aventis. G. Thomalla reports personal fees from Acandis, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Bristol-Myers Squibb/Pfizer, personal fees from Daichi Sankyo, personal fees from Stryker, outside the submitted work.

Ethical standards

This study, conducted on human subjects, was approved by the local ethics committee (Hamburg, Germany; MC-039/16) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients or their proxies, as appropriate, gave written informed consent prior to inclusion in the study. Consent was waived if patients died before consent could be obtained or lacked the capacity to give consent and no proxy was available.

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62_2019_850_MOESM1_ESM.pdf

Tables containing the different devices used in this study and the detailed information about the periprocedural complications and the complications during the hospital stay

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Deb-Chatterji, M., Flottmann, F., Leischner, H. et al. Recanalization is the Key for Better Outcome of Thrombectomy in Basilar Artery Occlusion. Clin Neuroradiol 30, 769–775 (2020). https://doi.org/10.1007/s00062-019-00850-9

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