Mechanical Thrombectomy in Basilar Artery Occlusion

Presence of Bilateral Posterior Communicating Arteries is a Predictor of Favorable Clinical Outcome
  • Volker Maus
  • Alev Kalkan
  • Christoph Kabbasch
  • Nuran Abdullayev
  • Henning Stetefeld
  • Utako Birgit Barnikol
  • Thomas Liebig
  • Christian Dohmen
  • Gereon Rudolf Fink
  • Jan Borggrefe
  • Anastasios Mpotsaris
Original Article
  • 106 Downloads

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.

Keywords

Embolectomy Collateral Circulation Cerebral Stroke Cerebrovascular Occlusion Intracranial Thrombosis 

Notes

Compliance with ethical guidelines

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Volker Maus
    • 1
  • Alev Kalkan
    • 1
  • Christoph Kabbasch
    • 1
  • Nuran Abdullayev
    • 1
  • Henning Stetefeld
    • 2
  • Utako Birgit Barnikol
    • 3
  • Thomas Liebig
    • 4
  • Christian Dohmen
    • 2
  • Gereon Rudolf Fink
    • 2
    • 5
  • Jan Borggrefe
    • 1
  • Anastasios Mpotsaris
    • 6
  1. 1.Department of NeuroradiologyUniversity Hospital CologneCologneGermany
  2. 2.Department of NeurologyUniversity Hospital CologneCologneGermany
  3. 3.Clearing Unit Ethics, Medical Faculty of Cologne & Research Unit Ethics, Department of Child and Adolescence PsychiatryUniversity Hospital CologneCologneGermany
  4. 4.Department of NeuroradiologyCharitéBerlinGermany
  5. 5.Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3)Research Centre JülichJülichGermany
  6. 6.Department of NeuroradiologyUniversity Hospital AachenAachenGermany

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