[en] [en] BACKGROUND: The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes.
METHODS: We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect.
RESULTS: We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901).
CONCLUSIONS: We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.
Disciplines :
Neurology
Author, co-author :
de Havenon, Adam ; Department of Neurology, Yale University, New Haven, Connecticut, USA adam.dehavenon@yale.edu
Elhorany, Mahmoud; Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
Boulouis, Gregoire ; Neuroradiology, Hôpital Sainte-Anne, Paris, France
Naggara, Olivier; Neuroradiology, Hôpital Sainte-Anne, Paris, France
Darcourt, Jean; Neuroradiology, CHU de Toulouse, Toulouse, France
Clarençon, Frédéric; Sorbonne Université, Paris, France ; Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
Richard, Sébastien ; Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Bourcier, Romain; Neuroradiology, Université de Nantes, Nantes, France
Sibon, Igor; CHU de Bordeaux, Bordeaux, France
Arquizan, Caroline; Neurology, CHRU Gui de Chauliac, Montpellier, France
Dargazanli, Cyril; Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
Maïer, Benjamin; Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
Seners, Pierre; Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
Lapergue, Bertrand; Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
Consoli, Arturo ; Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France ; Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
Eugene, Francois ; Radiologie, CHU Rennes, Rennes, France
Vannier, Stephane; Department of Neurology, CHU Rennes, Rennes, Bretagne, France
Caroff, Jildaz ; Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
Denier, Christian; Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
Boulanger, Marion; Department of Neurology, CHU Caen, Caen, France
Gauberti, Maxime; CHU Caen, Caen, Basse-Normandie, France
Rouchaud, Aymeric ; Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France ; Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
Macian, Francisco; Department of Neurology, CHU Limoges, Limoges, France
Rosso, Charlotte; Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
Turc, Guillaume ; Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
Ozkul-Wermester, Ozlem; Department of Neurology, CHU Rouen, Rouen, France
Papagiannaki, Chrisanthi; CHU Rouen, Rouen, Normandie, France
Albucher, Jean François; Neurology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
Le Bras, Anthony ; Department of Radiology, CH Bretagne Atlantique, Vannes, France ; CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
Evain, Sarah; Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
Wolff, Valerie; Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
Pop, Raoul ; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France ; Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
Timsit, Serge; Department of Neurology, CHU Brest, Brest, France
Bourdain, Frédéric; CH Côte Basque, Bayonne, France
Veunac, Louis; Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
Fahed, Robert ; Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada ; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
Finitsis, Stephanos Nikolaos ; Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada ; Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada
Gory, Benjamin; Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
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