Advertisement

Neuroradiology

, Volume 59, Issue 3, pp 297–304 | Cite as

Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion—a retrospective single center experience

  • Johannes C. GerberEmail author
  • Dirk Daubner
  • Daniel Kaiser
  • Kay Engellandt
  • Kevin Haedrich
  • Angela Mueller
  • Volker Puetz
  • Jennifer Linn
  • Andrij Abramyuk
Interventional Neuroradiology

Abstract

Introduction

The study aimed to compare efficacy and safety of aspiration thrombectomy (AT) to stentriever thrombectomy (SRT) in patients with basilar artery (BA) occlusion (BAO).

Methods

We retrospectively included patients with the following characteristics: acute BAO or occlusion of the intracranial vertebral artery (ICVA) and endovascular therapy (EVT) with stentriever (SRT) or aspiration thrombectomy (AT). Additional extra- but not intracranial EVT and intravenous thrombolysis (IVT) were allowed.

Results

Between January 2013 and April 2016, 33 patients fulfilled the criteria (13 treated with SRT, 20 with AT). Prior to EVT, 23 (70%) patients received IVT. The proximal intracranial occlusion was ICVA in 2 patients, proximal BA in 5 patients, middle BA in 20 patients, and distal BA in 6 patients. Mean time to treatment was 334 min (95% CI 276–391 min). Procedure duration differed significantly (p = 0.002) as follows: 97 min with SRT (95% CI 69–124 min) and 55 min with AT (95% CI 43–66 min). Recanalization (arterial occlusive lesion (AOL) 2/3) was achieved in 26 patients (79%). Complete recanalization (AOL 3) happened more often with AT (75% (95% CI 65–85%)) compared to SRT (46% (95% CI 32–60%)). Conversion rate 6% (two patients). Hemorrhages occurred in 12 (36%) patients, periprocedural complications in eight (three dissections, five embolizations to new territory) (no group difference). Ten patients (30%) had a favorable outcome (mRS ≤3) at discharge; mortality rate was 24% (eight deaths) (no group difference).

Conclusion

In primarily embolic BAO, aspiration thrombectomy was faster, effective and not detrimental to outcome as compared to stentriever thrombectomy. Thus, it may be justified to use aspiration thrombectomy as first-line treatment in these patients.

Keywords

Stroke Basilar artery occlusion Endovascular treatment Stent retriever Aspiration thrombectomy 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

JCG has speaking engagements with Penumbra Inc.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Supplementary material

234_2017_1802_MOESM1_ESM.docx (306 kb)
ESM 1 (DOCX 306 kb)

References

  1. 1.
    Schonewille WJ, Wijman CA, Michel P et al (2009) Treatment and outcomes of acute basilar artery occlusion in the basilar artery international cooperation study (BASICS): a prospective registry study. Lancet Neurol 8:724–730. doi: 10.1016/S1474-4422(09)70173-5 CrossRefPubMedGoogle Scholar
  2. 2.
    Sairanen T, Strbian D, Soinne L et al (2011) Intravenous thrombolysis of basilar artery occlusion: predictors of recanalization and outcome. Stroke 42:2175–2179. doi: 10.1161/STROKEAHA.110.605584 CrossRefPubMedGoogle Scholar
  3. 3.
    Jung S, Mono M-L, Fischer U et al (2011) Three-month and long-term outcomes and their predictors in acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke 42:1946–1951. doi: 10.1161/STROKEAHA.110.606038 CrossRefPubMedGoogle Scholar
  4. 4.
    van der Hoeven EJRJ, Schonewille WJ, Vos JA et al (2013) The basilar artery international cooperation study (BASICS): study protocol for a randomised controlled trial. Trials 14:200. doi: 10.1186/1745-6215-14-200 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England) 387:1723–1731. doi: 10.1016/S0140-6736(16)00163-X CrossRefGoogle Scholar
  6. 6.
    Powers WJ, Derdeyn CP, Biller J et al (2015) 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American. Stroke 46:3020–3035. doi: 10.1161/STR.0000000000000074 CrossRefPubMedGoogle Scholar
  7. 7.
    Goyal M, Almekhlafi M, Menon B et al (2014) Challenges of acute endovascular stroke trials. Stroke 45:3116–3122. doi: 10.1161/STROKEAHA.114.006288 CrossRefPubMedGoogle Scholar
  8. 8.
    Campbell BCV, Donnan GA, Lees KR et al (2015) Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol 14:846–854. doi: 10.1016/S1474-4422(15)00140-4 CrossRefPubMedGoogle Scholar
  9. 9.
    Mokin M, Setlur Nagesh SV, Ionita CN et al (2015) Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. AJNR Am J Neuroradiol 36:547–551. doi: 10.3174/ajnr.A4149 CrossRefPubMedGoogle Scholar
  10. 10.
    Delgado Almandoz JE, Kayan Y, Young ML et al (2015) Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg neurintsurg 8:1123–1128. doi: 10.1136/neurintsurg-2015-012122 CrossRefGoogle Scholar
  11. 11.
    Lapergue B, Blanc R, Guedin P et al (2016) A direct aspiration, first pass technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study. AJNR Am J Neuroradiol. doi: 10.3174/ajnr.A4840 Google Scholar
  12. 12.
    Son S, Choi DS, Oh MK et al (2014) Comparison of solitaire thrombectomy and penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg neurintsurg 8:13–18. doi: 10.1136/neurintsurg-2014-011472 CrossRefGoogle Scholar
  13. 13.
    Mokin M, Sonig A, Sivakanthan S et al (2016) Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke 47:782–788. doi: 10.1161/STROKEAHA.115.011598 PubMedGoogle Scholar
  14. 14.
    Voetsch B, DeWitt LD, Pessin MS, Caplan LR (2004) Basilar artery occlusive disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 61:496–504. doi: 10.1001/archneur.61.4.496 CrossRefPubMedGoogle Scholar
  15. 15.
    von Kummer R, Broderick JP, Campbell BCV et al (2015) The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 46:2981–2986. doi: 10.1161/STROKEAHA.115.010049 CrossRefGoogle Scholar
  16. 16.
    Archer CR, Horenstein S (1977) Basilar artery occlusion: clinical and radiological correlation. Stroke 8:383–390. doi: 10.1161/01.STR.8.3.383 CrossRefPubMedGoogle Scholar
  17. 17.
    Puetz V, Dzialowski I, Hill MD et al (2008) Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. Int J Stroke 3:230–236CrossRefPubMedGoogle Scholar
  18. 18.
    Turk AS, Spiotta A, Frei D et al (2014) Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 6:231–237. doi: 10.1136/neurintsurg-2013-010713 CrossRefPubMedGoogle Scholar
  19. 19.
    Zaidat OO, Yoo AJ, Khatri P et al (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44:2650–2663. doi: 10.1161/STROKEAHA.113.001972 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jung C, Yoon W, Ahn SJ et al (2016) The revascularization scales dilemma: is it right to apply the treatment in cerebral ischemia scale in posterior circulation stroke? AJNR Am J Neuroradiol 37:285–289. doi: 10.3174/ajnr.A4529 CrossRefPubMedGoogle Scholar
  21. 21.
    Turk AS, Frei D, Fiorella D et al (2014) ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 6:260–264. doi: 10.1136/neurintsurg-2014-011125 CrossRefPubMedGoogle Scholar
  22. 22.
    Madjidyar J, Hermes J, Freitag-Wolf S, Jansen O (2015) Stent-thrombus interaction and the influence of aspiration on mechanical thrombectomy: evaluation of different stent retrievers in a circulation model. Neuroradiology. doi: 10.1007/s00234-015-1526-4 PubMedGoogle Scholar
  23. 23.
    Mühl-Benninghaus R, Körner H, Simgen A et al (2015) Intermediate catheters reduce the length of mechanical thrombectomy procedures in acute basilar artery occlusions. Clin Neuroradiol. doi: 10.1007/s00062-014-0368-5 Google Scholar
  24. 24.
    Deshaies EM (2013) Tri-axial system using the solitaire-FR and penumbra aspiration microcatheter for acute mechanical thrombectomy. J Clin Neurosci 20:1303–1305. doi: 10.1016/j.jocn.2012.10.037 CrossRefPubMedGoogle Scholar
  25. 25.
    Jankowitz B, Grandhi R, Horev A et al (2015) Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients. J Neurointerv Surg 7:27–31. doi: 10.1136/neurintsurg-2013-011024 CrossRefPubMedGoogle Scholar
  26. 26.
    Gory B, Eldesouky I, Sivan-Hoffmann R et al (2016) Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review. J Neurol Neurosurg Psychiatry 87:520–525. doi: 10.1136/jnnp-2014-310250 CrossRefPubMedGoogle Scholar
  27. 27.
    Singer OC, Berkefeld J, Nolte CH et al (2015) Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 77:415–424. doi: 10.1002/ana.24336 CrossRefPubMedGoogle Scholar
  28. 28.
    Yoo AJ, Simonsen CZ, Prabhakaran S et al (2013) Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 44:2509–2512. doi: 10.1161/STROKEAHA.113.001990 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Puetz V, Sylaja PN, Hill MD et al (2009) CT angiography source images predict final infarct extent in patients with basilar artery occlusion. AJNR Am J Neuroradiol 30:1877–1883. doi: 10.3174/ajnr.A1723 CrossRefPubMedGoogle Scholar
  30. 30.
    Sairanen T, Strbian D, Ruuskanen R et al (2015) Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion. Eur J Neurol 22:493–499. doi: 10.1111/ene.12597 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Johannes C. Gerber
    • 1
    Email author
  • Dirk Daubner
    • 1
  • Daniel Kaiser
    • 1
  • Kay Engellandt
    • 1
  • Kevin Haedrich
    • 1
  • Angela Mueller
    • 1
  • Volker Puetz
    • 2
  • Jennifer Linn
    • 1
  • Andrij Abramyuk
    • 1
  1. 1.NeuroradiologyUniversity Hospital Carl Gustav CarusDresdenGermany
  2. 2.NeurologyUniversity Hospital Carl Gustav CarusDresdenGermany

Personalised recommendations