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SNIS 9th annual meeting oral poster abstracts
P-006 Angiographic and clinical outcomes after endovascular therapy for acute ischemic stroke due to vertebrobasilar occlusions: pooled analysis of the Merci Registry, MERCI, and multi MERCI trials
  1. R Nogueira1,
  2. T Jovin2,
  3. W Smith3,
  4. M Rymer4,
  5. D Liebeskind5,
  6. R Budzik6,
  7. T Devlin7,
  8. G Walker8,
  9. H Lutsep9
  1. 1Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennysylania, USA
  3. 3Department of Neurology, University of California San Francisco, San Francisco, California, USA
  4. 4Department of Neurology, Saint Luke's Medical Center, Kansas City, Missouri, USA
  5. 5Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
  6. 6Department of Radiology, Riverside Medical Center, Columbus, Ohio, USA
  7. 7Department of Neurology, Erlanger Regional Stroke Center, Chattanooga, Tennessee, USA
  8. 8Clinical Research, Concentric Medical, Inc, Mountain View, California, USA
  9. 9Department of Neurology, OHSU, Portland, Oregon, USA

Abstract

Objective To describe the results of endovascular thrombectomy in a large prospective cohort of Acute Basilar Artery Occlusion (BAO) patients.

Background BAO is a serious but uncommon condition accounting for only 6%–10% of large-vessel strokes.

Design/Methods Our cohort included all BAO patients from three different prospective thrombectomy studies - the MERCI trial, the Multi MERCI trial, and the MERCI Registry. Successful recanalization was defined as TIMI 2–3 in the Merci/Multi-Merci trials and TICI 2–3 in the Merci Registry. Good Outcomes was defined as 90-day mRS 2.

Results Ninety-nine patients were identified (mean age, 61.6±15 years (range, 31–93); male gender, 70.7%; mean baseline NIHSS, 20.5±9.4 (median, 19); baseline mRS0-1, 95.9%). Fourteen patients (14.1%) received pre-procedure IV rt-PA. The mean time-from-symptom-onset (TSO) to arterial puncture was 9.23±12.45 h (median, 6.15) with 34.1% of patients treated >8 h. All patients were treated with at least one pass of Merci (average, 2.3±1.6). Other treatments included: intra-arterial rt-PA/urokinase (53.5%), proximal angioplasty (22.1%, 19/86) or stenting (14.0%, 12/86), Penumbra (15.3%, 11/72), and other mechanical (29.1%, 25/86). Successful recanalization was achieved in 88.9% (88/99). The overall mean (median) NIHSS dropped from 20.5±9.4/19 on admission to 13.4±14.5/6 on discharge. The overall rate of good outcomes was 31.6% (31/98). 90-day mortality was 38.8% (38/98). The SICH rate was 8.9% (7/79). The rate of good outcome was numerically higher (34.5% vs 9.1%) and mortality was numerically lower (36.8% vs 54.5%) in the revascularized vs non-revascularized patients. Notably, only one of 31 (3.2%) patients achieved a good outcome in the absence of recanalization. Patients with good outcome had significantly lower age (56.6 vs 63.6), baseline NIHSS (14.86 vs 23.15), and hypertension (51.6% vs 73.1%) but higher baseline functional status (mRS 0–1, 100% vs 93.8%) as compared to patients with bad outcomes. However, there was no difference in terms of TSO to puncture (9±13 vs 9±13 h), glucose levels (130±27 vs 152±62 mg/gl), intubation (82.6% vs 90.4%), or treatment modalities between these two groups.

Conclusions Mechanical thrombectomy in BAO appears to be associated higher recanalization rates than previous reports of intravenous or intra-arterial thrombolysis. In concordance to previous studies, the chances of good outcomes are dismal in the absence of recanalization.

Competing interests R Nogueira: Concentric Medical, Inc., ev3 neurovascular, Coaxia, Rapid Medical. T Jovin: Concentric Medical; ev3 neurovascular; Coaxia. W Smith: Concentric Medical. M Rymer: Genetech. D Liebeskind: Concentric Medical; Coaxia. R Budzik: Concentric Medical. T Devlin: None. G Walker: Concentric Medical, Inc. H Lutsep: Concentric Medical.

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