[en] [en] BACKGROUND: Retrospective studies suggest the superiority of first-line contact aspiration (CA) thrombectomy over stent-retriever (SR) in basilar artery occlusions (BAO). We aimed to investigate the impact of first-line mechanical thrombectomy per the occlusion level, considering differences in stroke etiology prevalence between proximal and distal BAO.
METHODS: A retrospective, multicentric analysis of the Endovascular Treatment in Ischemic Stroke Registry (ETIS) included consecutive BAO patients treated from January 2016 to May 2022. Patients were categorized into SR (±aspiration) and CA alone groups. Occlusion levels were determined through digital subtraction angiography. Favorable clinical outcome was defined as 90-day modified Rankin Scale (mRS) 0-3.
RESULTS: A total of 380 patients were analyzed (251 CA alone, 129 SR±aspiration). Globally, first-line SR showed lower recanalization rates (89.1% vs 94.8%, OR=0.29, 95% CI 0.16 to 0.53; p<0.001) and worse clinical outcomes (mRS 0-3: 46.0% vs 52.2%, OR=0.62, 95% CI 0.44 to 0.87; p=0.006) compared with CA. In proximal occlusions, SR was significantly associated with poorer clinical outcomes (mRS 0-3: 20.9% vs 37.1%; OR=0.40, 95% CI 0.19 to 0.83; p=0.014) despite similar recanalization rates. Conversely, in distal occlusions there was no difference in clinical outcomes although recanalization rates were higher with CA (modified Thrombolysis in Cerebral Infarction score (mTICI 2b/3): 97.7% vs 91.7%; OR=0.17, 95% CI 0.05 to 0.66; p=0.01).
CONCLUSIONS: In our BAO population, CA demonstrated better angiographic outcomes in middle and distal occlusions and better clinical outcomes in proximal occlusions. This translated into better angiographic and clinical results in the global study population. Clinical results were particularly influenced by the negative impact of SR on 90-day mRS, independently of recanalization rates in proximal BAO.
Disciplines :
Neurology
Author, co-author :
Tournier, Louis ; Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
Cortese, Jonathan ; Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France ; Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicêtre, France
Consoli, Arturo ; Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
Spelle, Laurent ; Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France ; Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicêtre, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Sarov, Mariana; Neurology, Hopital Bicêtre, Le Kremlin-Bicêtre, France
Zhu, Francois; Service de Neuroradiologie Diagnostique et Thérapeutique, CHRU Nancy, Nancy, France
Soize, Sebastien; Neuroradiology, University Hospital Centre Reims Medical Imaging, Reims, France
Burel, Julien; Department of Radiology, CHU de Rouen, Rouen, France
Forestier, Géraud ; Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
Escalard, Simon ; Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
Pop, Raoul ; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
Bonnet, Baptiste; Neuroradiology, Hôpital Pitié-Salpétrière, Paris, France
Alias, Quentin; Neuroradiology, University Hospital of Rennes, Rennes, France
Ognard, Julien ; Department of Neuroradiology, University and Regional Hospital Centre Brest, Brest, France
Naggara, Olivier; Department of Neuroradiology, Center Hospitalier Sainte-Anne, Université Paris Descartes Faculté de Médecine, Paris, France
Kyheng, Maeva; Santé publique: épidémiologie et qualité des soins, University of Lille, Lille, France
Lapergue, Bertrand; Department of Neurology and Stroke Center, Hospital Foch, Suresnes, France
Caroff, Jildaz ; Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France jildaz.caroff@aphp.fr ; Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicêtre, France ; UMR-S INSERM U1176, Paris-Saclay University, Le Kremlin-Bicetre, France
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