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Basilar artery thrombectomy: assessment of outcome and identification of prognostic factors

  • Anh Tuan Tran
  • Huu An Nguyen
  • Dang Luu Vu
  • Minh Thong Pham
  • Cuong Tran
  • Hoang Kien Le
  • Quang Anh Nguyen
  • Thu Trang Nguyen
  • Tat Thien Nguyen
  • Pau Loke Show
  • Joanna Czarzasta
  • Thien Chu-DinhEmail author
  • Yang Tao
  • Dinh-Toi ChuEmail author
Original article
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Abstract

Mechanical thrombectomy (MT) has been demonstrated as an effective treatment for acute ischemic stroke (AIS), thanks to large vessel occlusion (LVO), especially in case of anterior cerebral artery with many randomized clinical trials (RCTs) every year. On the other hand, there is a limited number of basilar artery occlusion (BAO)-related studies which have been conducted. The fact prompts our range of case studies, which furnish BAO understanding with our experience, results and some prognosis factors of MT. This retrospective and single-center study was conducted on 22 patients who were diagnosed with BAO and underwent the treatment of MT from October 2012 to January 2018. Clinical feature such as radiological imaging, procedure complications, and intracranial hemorrhage were all documented and evaluated. All the studies’ results based on performance using modified Rankin scale score (mRS) and mortality at 90 days. The results from these BAO patients study indicated that the posterior circulation Acute Stroke Prognosis Early CT Score (pcASPECTS) recorded before the intervention was 7.7 ± 1.6, while the admission National Institutes of Health Stroke Scale (NIHSS) was 17.5 ± 5.4. 15/22 cases achieved successful recanalization (TICI, Thrombolysis in Cerebral Infarction scale, of 2b–3), accounting for 68.2%. The results highlighted 50% of the favorable outcome (mRS 0–2) occupying 11 out of 22 patients in total and the overall mortality was 36.4%. The intracranial hemorrhagic complication was detected in three cases (13.6%). Placing in juxtaposition the poor-outcome group and the favorable-outcome group, we could witness statistically significant difference (P < 0.05) suggesting both good baseline image (pc-ASPECTS ≥ 7) and recanalization (TICI 2b–3) were two good prognosis factors. Our case series showed that MT would be an effective and feasible treatment for BAO. The pre-procedural pcASPECTS ≥ 7 and post-procedural good recanalization (TICI 2b–3) were two important prognosis factors for predicting good clinical outcome.

Keywords

Basilar artery occlusion Acute ischemic stroke Mechanical thrombectomy 

Notes

Acknowledgements

We would like to thank MSc. Phuong Linh Nguyen (an English editor in biomedicine) for checking and improving the English in the revised manuscript.

Author contributions

ATT, HAN and DLV, MTP, CT, HKL, QAN, TTN, TTN designed, performed experiments and collected data and informed consents. ATT and TCD, JC and DTC analyzed and interpreted the results. ATT, HNA TCD and DTC wrote the manuscript. TCD, PLS, JC, YT and DTC edited the manuscript. All authors approved the final manuscript.

Funding

No funding was received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in 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. The research was approved by the institutional review board of Bach Mai Hospital.

Informed consent

Relatives of all patients have been explained the procedure and agreed to participate in treatment. Informed consents were obtained from relatives of the patients included in the study.

References

  1. 1.
    Hacke W, Zeumer H, Ferbert A, Brückmann H, Zoppo GJD (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusion disease. Stroke 137:545–571Google Scholar
  2. 2.
    Ferbert Andreas, Bruckmann Hartmut, Drummen R (1990) Clinical features of proven basilar artery occlusion. Stroke 21:1135–1142CrossRefGoogle Scholar
  3. 3.
    Demel SL, Broderick JP (2015) Basilar occlusion syndromes: an update. Neurohospitalist 5(3):142–150CrossRefGoogle Scholar
  4. 4.
    Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP 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(8):724–730CrossRefGoogle Scholar
  5. 5.
    Matsumoto K, Satoh K (1991) Topical intraarterial urokinase infusion for acute stroke. Springer, Berlin HeidelbergCrossRefGoogle Scholar
  6. 6.
    Andersson T, Kuntze Söderqvist Å, Söderman M, Holmin S, Wahlgren N, Kaijser M (2013) Mechanical thrombectomy as the primary treatment for acute basilar artery occlusion: experience from 5 years of practice. J Neurointerv Surg 5:221CrossRefGoogle Scholar
  7. 7.
    Espinosa de Rueda M, Parrilla G, Zamarro J, García-Villalba B, Hernández F, Moreno A (2013) Treatment of acute vertebrobasilar occlusion using thrombectomy with stent retrievers: initial experience with 18 patients. Am J Neuroradiol 34:1044CrossRefGoogle Scholar
  8. 8.
    Lutsep HL, Rymer MM, Nesbit GM (2008) Vertebrobasilar Revascularization Rates and Outcomes in the MERCI and multi-MERCI Trials. J Stroke Cerebrovasc Dis 17:55–57CrossRefGoogle Scholar
  9. 9.
    Pfefferkorn Thomas, Holtmannspötter Markus, Schmidt Caroline, Bender Andreas, Pfister Hans-Walter, Straube Andreas et al (2010) Cooperative recanalization therapy in acute basilar artery occlusion. Stroke 41:722–726CrossRefGoogle Scholar
  10. 10.
    Mourand I, Machi P, Milhaud D, Picot M-C, Lobotesis K, Arquizan C et al (2014) Mechanical thrombectomy with the Solitaire device in acute basilar artery occlusion. J Neurointerv Surg 6:200CrossRefGoogle Scholar
  11. 11.
    Mordasini P, Brekenfeld C, Byrne JV, Fischer U, Arnold M, Heldner MR et al (2013) Technical feasibility and application of mechanical thrombectomy with the solitaire fr revascularization device in acute basilar artery occlusion. Am J Neuroradiol 34:159–163CrossRefGoogle Scholar
  12. 12.
    Costalat V, Machi P, Lobotesis K, Lima Maldonado I, Vendrell J-F, Riquelme C et al (2011) Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study timing, safety, and efficacy. Stroke 42:1929–1935CrossRefGoogle Scholar
  13. 13.
    Delgado-Acosta F, Jiménez-Gómez E, de Asís-Bravo-Rodríguez F, Oteros-Fernández R, Ochoa-Sepúlveda JJ (2014) Vertebrobasilar recanalization modalities before the placement of stent-retrievers: reopening is not synonymous with good outcome. Radiología 56:44–51 ((English Edition)) CrossRefGoogle Scholar
  14. 14.
    Singer OC, Berkefeld J, Nolte CH, Bohner G et al (2015) Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 77:415–424CrossRefGoogle Scholar
  15. 15.
    Baek JM, Yoon W, Kim SK, Jung MY, Park MS, Kim JT et al (2014) Acute basilar artery occlusion: outcome of mechanical thrombectomy with solitaire stent within 8 hours of stroke onset. Am J Neuroradiol 35:989CrossRefGoogle Scholar
  16. 16.
    Werner M, Lopez-Rueda A, Zarco F, Román LS, Blasco J, Amaro S et al (2016) Mechanical thrombectomy in acute basilar artery occlusion: a safety and efficacy single centre study. Intervent Neuroradiol 22:310–317CrossRefGoogle Scholar
  17. 17.
    Hacke Werner, Zeumer Hermann, Ferbert Andreas, Briickmann Hartmut, Zoppo GJD (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216CrossRefGoogle Scholar
  18. 18.
    Lindsberg PJ, Soinne L, Tatlisumak T et al (2004) Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA 292:1862–1866CrossRefGoogle Scholar
  19. 19.
    Kumar G, Shahripour RB, Alexandrov AV (2015) Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis. J Neurointerv Surg 7:868CrossRefGoogle Scholar
  20. 20.
    Alonso de Lecinana M, Kawiorski MM, Ximenez-Carrillo A, Cruz-Culebras A, Garcia-Pastor A et al (2017) Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions. J Neurointerv Surg 9(12):1173–1178CrossRefGoogle Scholar
  21. 21.
    Jung S, Mono M-L, Fischer U, Galimanis A, Findling O et al (2011) Three-month and long-term outcomes and their predictors in acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke 42:1946CrossRefGoogle Scholar
  22. 22.
    Lees KR, Bluhmki E, Von Kummer R, Brott TG et al (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703CrossRefGoogle Scholar
  23. 23.
    Yeung JT, Matouk CC, Bulsara KR, Sheth KN (2014) Endovascular revascularization for basilar artery occlusion. Interv Neurol 3(1):31–40CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  • Anh Tuan Tran
    • 1
  • Huu An Nguyen
    • 1
  • Dang Luu Vu
    • 1
  • Minh Thong Pham
    • 1
  • Cuong Tran
    • 1
  • Hoang Kien Le
    • 1
  • Quang Anh Nguyen
    • 1
  • Thu Trang Nguyen
    • 1
  • Tat Thien Nguyen
    • 1
  • Pau Loke Show
    • 2
  • Joanna Czarzasta
    • 3
  • Thien Chu-Dinh
    • 4
    Email author
  • Yang Tao
    • 5
  • Dinh-Toi Chu
    • 6
    • 7
    Email author
  1. 1.Radiology DepartmentBach Mai HospitalHanoiVietnam
  2. 2.Department of Chemical and Environmental Engineering, Faculty of EngineeringUniversity of Nottingham Malaysia CampusSemenyihMalaysia
  3. 3.Department of Pathophysiology, School of MedicineUniversity of Warmia and MazuryOlsztynPoland
  4. 4.Institute for Research and DevelopmentDuy Tan UniversityDanangVietnam
  5. 5.College of Food Science and TechnologyNanjing Agricultural UniversityNanjing 8China
  6. 6.Faculty of BiologyHanoi National University of EducationHanoiVietnam
  7. 7.School of Odonto StomatologyHanoi Medical UniversityHanoiVietnam

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