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Revascularization Techniques for Acute Basilar Artery Occlusion

Technical Considerations and Outcome in the Setting of Severe Posterior Circulation Steno-Occlusive Disease

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Abstract

Purpose

To describe the clinical and radiological characteristics, frequency, technical aspects and outcome of endovascular treatment of acute basilar artery occlusion (ABO) in the setting of vertebrobasilar steno-occlusive disease.

Methods

Retrospective analysis of databases of two universitary stroke centers including all consecutive patients from January 2013 until May 2017 undergoing thrombectomy for a) acute stroke due to basilar artery occlusion and either significant basilar artery stenosis or vertebral artery stenosis/occlusion as well as b) presumed embolic basilar artery occlusions. Demographics, stroke characteristics, time metrics, recanalization results and outcome were recorded. Interventional strategies were evaluated concerning the thrombectomy technique, additional angioplasty, type of approach with respect to lesion pattern (ipsilateral to steno-occlusive VA lesion: dirty road or contralateral: clean road) and sequence of actions.

Results

Out of 157 patients treated for ABO 38 (24.2%) had associated significant vertebrobasilar steno-occlusive lesions. An underlying significant basilar artery stenosis was present in 23.7% and additionally significant steno-occlusive vertebral lesions were present in 81.5%. Thrombectomy was performed with primary aspiration in 15.8% and with stent-retrievers in 84.2%. Successful revascularization (TICI 2b-3) was achieved in 86.8%. In 52.6% additional stent angioplasty was performed, in 7.9% balloon angioplasty only. The clean road approach was used in 22.5% of cases, the dirty road in 77.4%. Final modified Rankin scale (mRS) was 0–2 in 6 patients (15.8%) and 3–5 in 32 (84.2%). The in-hospital mortality was 36.8%. There were no statistically significant differences in outcome compared to presumed cases of embolisms.

Conclusion

Endovascular treatment of ABO with underlying significant vertebrobasilar steno-occlusive lesions is effective and reasonably safe. Specific procedural strategies apply depending on individual patient pathology and anatomy. Although high rates of recanalization can be achieved, outcomes tend to be poor.

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Authors and Affiliations

  1. Institute of Neuroradiology, Charité—University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Eberhard Siebert, Georg Bohner & Thomas Liebig

  2. Dept. of Neurology, Charité—University Medicine Berlin, Berlin, Germany

    Sarah Zweynert

  3. Dept. of Neuroradiology, University Hospital of Cologne, Cologne, Germany

    Volker Maus, Anastasios Mpotsaris & Christoph Kabbasch

  4. Dept. of Neuroradiology, University Hospital of Aachen, Aachen, Germany

    Anastasios Mpotsaris

Authors
  1. Eberhard Siebert
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  2. Georg Bohner
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  3. Sarah Zweynert
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  4. Volker Maus
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  5. Anastasios Mpotsaris
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  6. Thomas Liebig
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  7. Christoph Kabbasch
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Correspondence to Eberhard Siebert.

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Conflict of interest

E. Siebert, G. Bohner, S. Zweynert, V. Maus, A. Mpotsaris, T. Liebig and C. Kabbasch declare that they have no competing interests.

Ethical standards

The study was approved by the institutional ethics committee in Berlin. According to the guidelines of the local ethics committee in Cologne, no approval was necessary for conducting this retrospective, observational study.

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Siebert, E., Bohner, G., Zweynert, S. et al. Revascularization Techniques for Acute Basilar Artery Occlusion. Clin Neuroradiol 29, 435–443 (2019). https://doi.org/10.1007/s00062-018-0683-3

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  • DOI: https://doi.org/10.1007/s00062-018-0683-3

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