Thrombectomy for Basilar Artery Occlusion with Mild Symptoms.

Endovascular recanalization; Mild symptoms; Stroke; Thrombectomy; Aged; Female; Humans; Ischemic Stroke/etiology; Ischemic Stroke/surgery; Male; Middle Aged; Retrospective Studies; Risk Factors; Thrombectomy/methods; Treatment Outcome; Vertebrobasilar Insufficiency/complications; Vertebrobasilar Insufficiency/surgery; Ischemic Stroke; Vertebrobasilar Insufficiency; Surgery; Neurology (clinical)

Abstract :

[en] [en] BACKGROUND AND OBJECTIVE: To evaluate outcomes of thrombectomy in patients with a basilar artery occlusion (BAO) and mild symptoms, defined by an initial National Institutes of Health Stroke Scale (NIHSS) score ≤6. METHODS: We performed a retrospective analysis of a multicenter prospective cohort of consecutive patients with acute ischemic stroke with BAO who underwent thrombectomy. We compared baseline and procedural characteristics, as well as outcomes between patients with BAO with an NIHSS score ≤6 and >6. Multivariate analyses were performed to determine baseline and procedural predictors of good outcome (modified Rankin Scale score 0-2) among patients with an NIHSS score ≤6. RESULTS: A total of 269 patients were included: 50 (19%) had an initial NIHSS score ≤6 and 219 (81%) had an NIHSS score >6. Patients with mild strokes (NIHSS score ≤6) had better outcomes (68% of modified Rankin Scale score 0-2 vs. 27% for NIHSS score >6; P < 0.0001), lower mortality (14% vs. 48; P < 0.0001) and fewer parenchymal hematomas at day 1 (0% vs. 10%; P = 0.016). A multivariate analysis identified the following predictors for good outcome among patients with BAO with an NIHSS score ≤6: younger age, fewer passes, a cardioembolic cause, and the absence of need for angioplasty/stenting. CONCLUSIONS: Thrombectomy seems to be safer and more effective for mild BAO strokes with NIHSS score ≤6 than for more severe patients. Even although thrombectomy showed high rates of recanalization, a substantial proportion (32%) nevertheless had a poor long-term clinical outcome. The number of passes, patient's age, and stroke cause seem to be predictors of clinical outcome.

Disciplines :

Neurology

Author, co-author :

Guenego, Adrien; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France, Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

Dargazanli, Cyril; Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France

Weisenburger-Lile, David; Neurovascular Unit, Foch Hospital, Suresnes, France

Gory, Benjamin; Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy and Université de Lorraine, IADI, INSERM U1254, Nancy, France

Richard, Sébastien; Stroke Unit, Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, and INSERM U1116, CHRU-Nancy, Nancy, France

Ducroux, Célina; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France

Piotin, Michel; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France

Blanc, Raphael; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France

Labreuche, Julien; Université de Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France

Lucas, Ludovic; Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

More authors (13 more)

Other collaborator :

Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques

Language :

English

Title :

Thrombectomy for Basilar Artery Occlusion with Mild Symptoms.

Publication date :

May 2021

Journal title :

World Neurosurgery

ISSN :

1878-8750

eISSN :

1878-8769

Publisher :

Elsevier Inc., United States

Volume :

149

Pages :

e400 - e414

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S1878875021001911?httpAccept=text/xml

Available on ORBi :

since 20 January 2025

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Bibliography

Goyal, M., Menon, B.K., van Zwam, W.H., et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387 (2016), 1723–1731.
Powers, W.J., Rabinstein, A.A., Ackerson, T., et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50 (2019), e344–e418.
Schonewille, W.J., Wijman, C.A., Michel, P., et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 8 (2009), 724–730.
Schonewille, W.J., Algra, A., Serena, J., Molina, C.A., Kappelle, L.J., Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry 76 (2005), 1238–1241.
Hacke, W., Zeumer, H., Ferbert, A., Bruckmann, H., del Zoppo, G.J., Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19 (1988), 1216–1222.
Liu, X., Dai, Q., Ye, R., et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 19 (2020), 115–122.
Dargazanli, C., Arquizan, C., Gory, B., et al. Mechanical thrombectomy for minor and mild stroke patients harboring large vessel occlusion in the anterior circulation: a multicenter cohort study. Stroke 48 (2017), 3274–3281.
Dargazanli, C., Consoli, A., Gory, B., et al. Is reperfusion useful in ischaemic stroke patients presenting with a low National Institutes of Health Stroke Scale and a proximal large vessel occlusion of the anterior circulation?. Cerebrovasc Dis 43 (2017), 305–312.
Nagel, S., Bouslama, M., Krause, L.U., et al. Mechanical thrombectomy in patients with milder strokes and large vessel occlusions. Stroke 49 (2018), 2391–2397.
Albers, G.W., Marks, M.P., Kemp, S., et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378 (2018), 708–718.
Jovin, T.G., Chamorro, A., Cobo, E., et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 (2015), 2296–2306.
Turc, G., Bhogal, P., Fischer, U., et al. European Stroke Organisation (ESO)–European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 11 (2019), 535–538.
Bouslama, M., Haussen, D.C., Aghaebrahim, A., et al. Predictors of good outcome after endovascular therapy for vertebrobasilar occlusion stroke. Stroke 48 (2017), 3252–3257.
Singer, O.C., Berkefeld, J., Nolte, C.H., et al. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 77 (2015), 415–424.
Lee, Y.Y., Yoon, W., Kim, S.K., et al. Acute basilar artery occlusion: differences in characteristics and outcomes after endovascular therapy between patients with and without underlying severe atherosclerotic stenosis. AJNR Am J Neuroradiol 38 (2017), 1600–1604.
Zhang, X., Luo, G., Jia, B., et al. Differences in characteristics and outcomes after endovascular therapy: a single-center analysis of patients with vertebrobasilar occlusion due to underlying intracranial atherosclerosis disease and embolism. Interv Neuroradiol 25 (2019), 254–260.
Ducroux, C., Piotin, M., Gory, B., et al. First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial. J Neurointerv Surg 12 (2020), 386–391.
Zaidat, O.O., Castonguay, A.C., Linfante, I., et al. First pass effect: a new measure for stroke thrombectomy devices. Stroke 49 (2018), 660–666.
Haussen, D.C., Bouslama, M., Grossberg, J.A., et al. Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis. J Neurointerv Surg 9 (2017), 917–921.
Heldner, M.R., Jung, S., Zubler, C., et al. Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients. J Neurol Neurosurg Psychiatry 86 (2015), 755–760.
Lee, V.H., Thakur, G., Nimjee, S.M., et al. Early neurologic decline in acute ischemic stroke patients receiving thrombolysis with large vessel occlusion and mild deficits. J Neurointerv Surg 12 (2020), 1085–1087.
Powers, W.J., Rabinstein, A.A., Ackerson, T., et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49 (2018), e46–e110.
Kaesmacher, J., Chaloulos-Iakovidis, P., Panos, L., et al. Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry. J Neurol 266 (2019), 598–608.
Wolman, D.N., Marcellus, D.G., Lansberg, M.G., et al. Endovascular versus medical therapy for large-vessel anterior occlusive stroke presenting with mild symptoms. Int J Stroke 15 (2020), 324–331.
Kang, D.H., Jung, C., Yoon, W., et al. Endovascular thrombectomy for acute basilar artery occlusion: a multicenter retrospective observational study. J Am Heart Assoc, 7, 2018, e009419.