Background Acute vertebro-basilar stroke (AVBS) often results in significant mortality and morbidity if recanalization is not achieved. Restoration of blood flow can be achieved with intravenous thrombolysis (IVT), endovascular therapy, including thrombolysis, mechanical thrombectomy or stenting or a combination of these therapies. Recent evidence suggests recanalization rates may be higher with endovascular techniques as compared to IVT alone; however, endovascular intervention is not without faults. By introducing an intra-arterial catheter, damage to the endothelial wall may occur resulting in increased risk of secondary thrombus formation. Antiplatelet and/or anticoagulation therapy is often prescribed post-operatively to maintain vessel patency, but their use exposes patients to higher risk of hemorrhagic complications. Because of the rarity of AVBS, there has been limited data available on the management of patients after receiving endovascular intervention. In this study, we performed a systematic review on a decade of relevant English literature to evaluate the safety and efficacy of post-operative administration of antiplatelet and/or anticoagulation therapy in AVBS patients.
Methods A literature review was conducted using Pubmed and Ovid databases to identify papers published from 1/1/2005 to 12/31/2015 on topics related to endovascular intervention in patients presenting with AVBS by using “basilar artery occlusion,” “mechanical thrombectomy,” or “basilar artery thrombosis” as keywords. Manual sorting further reduced the list until only relevant papers remained. Data including but not limited to patient demographics, occlusion location, intervention, pre- and post-operation assessment, post-operative medications, and complications were collected. The exclusion criteria limited selection to studies with >5 patients, data on post-intervention treatment, and 3 month follow-up. Good outcome was defined as modified Rankin scale ≤2. (We have requested data from studies with missing information and it will be included in the final analysis.)
Results After application of the selection criteria on initial screening [PubMed (n=2121), Ovid (n=3622)], we included 5 studies with 85 patients. Median age was 69%±11. 63% patients were male. Post procedure, 17% patients were on antiplatelet therapy (APT), 19% patients were on anticoagulation therapy (ACT) and 29% patients were on both. 35% patients were on no treatment. Patients on any treatment (APT or ACT or both) fared better than patients on no treatment (p<0.001) with a predictably higher rate of hemorrhagic complications (17% versus 0%; p=0.046). No statistical difference was observed in patients on APT versus ACT in respect to good outcome or hemorrhagic complications.
Conclusion Preliminary analysis of this ongoing systematic review did not show any differences in outcome or hemorrhagic complications in patients with AVBS on APT versus ACT post intervention. Either modality of treatment was superior to no treatment with a higher risk of hemorrhagic complications.
Disclosures M. Weber: None. N. Khan: None. F. Siddiqui: None. J. Blessman: None. A. Elias: None.
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