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Ischemic stroke
Original research
Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion
  1. Adam de Havenon1,
  2. Mahmoud Elhorany2,
  3. Gregoire Boulouis3,
  4. Olivier Naggara3,
  5. Jean Darcourt4,
  6. Frédéric Clarençon5,6,
  7. Sébastien Richard7,
  8. Gaultier Marnat8,
  9. Romain Bourcier9,
  10. Igor Sibon10,
  11. Caroline Arquizan11,
  12. Cyril Dargazanli12,
  13. Benjamin Maïer13,
  14. Pierre Seners14,
  15. Bertrand Lapergue15,
  16. Arturo Consoli16,17,
  17. Francois Eugene18,
  18. Stephane Vannier19,
  19. Jildaz Caroff20,
  20. Christian Denier21,
  21. Marion Boulanger22,
  22. Maxime Gauberti23,
  23. Aymeric Rouchaud24,25,
  24. Francisco Macian26,
  25. Charlotte Rosso27,
  26. Guillaume Turc28,
  27. Ozlem Ozkul-Wermester29,
  28. Chrisanthi Papagiannaki30,
  29. Jean François Albucher31,
  30. Anthony Le Bras32,33,
  31. Sarah Evain34,
  32. Valerie Wolff35,
  33. Raoul Pop36,37,
  34. Serge Timsit38,
  35. Jean-Christophe Gentric39,
  36. Frédéric Bourdain40,
  37. Louis Veunac41,
  38. Robert Fahed42,43,
  39. Stephanos Nikolaos Finitsis44,44,
  40. Benjamin Gory45
  41. On behalf of the ETIS Registry Investigators
    1. 1 Department of Neurology, Yale University, New Haven, Connecticut, USA
    2. 2 Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
    3. 3 Neuroradiology, Hôpital Sainte-Anne, Paris, France
    4. 4 Neuroradiology, CHU de Toulouse, Toulouse, France
    5. 5 Sorbonne Université, Paris, France
    6. 6 Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
    7. 7 Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
    8. 8 Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    9. 9 Neuroradiology, Université de Nantes, Nantes, France
    10. 10 CHU de Bordeaux, Bordeaux, France
    11. 11 Neurology, CHRU Gui de Chauliac, Montpellier, France
    12. 12 Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
    13. 13 Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
    14. 14 Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France
    15. 15 Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
    16. 16 Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
    17. 17 Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
    18. 18 Radiologie, CHU Rennes, Rennes, France
    19. 19 Department of Neurology, CHU Rennes, Rennes, Bretagne, France
    20. 20 Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
    21. 21 Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
    22. 22 Department of Neurology, CHU Caen, Caen, France
    23. 23 CHU Caen, Caen, Basse-Normandie, France
    24. 24 Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
    25. 25 Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
    26. 26 Department of Neurology, CHU Limoges, Limoges, France
    27. 27 Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
    28. 28 Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
    29. 29 Department of Neurology, CHU Rouen, Rouen, France
    30. 30 CHU Rouen, Rouen, Normandie, France
    31. 31 Neurology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
    32. 32 Department of Radiology, CH Bretagne Atlantique, Vannes, France
    33. 33 CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
    34. 34 Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
    35. 35 Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
    36. 36 Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
    37. 37 Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
    38. 38 Department of Neurology, CHU Brest, Brest, France
    39. 39 CHUM Montreal, Montréal, Québec, Canada
    40. 40 CH Côte Basque, Bayonne, France
    41. 41 Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
    42. 42 Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
    43. 43 Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
    44. 44 Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada
    45. 45 Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
    1. Correspondence to Dr Adam de Havenon, Department of Neurology, Yale University, New Haven, Connecticut, USA; adam.dehavenon{at}yale.edu

    Abstract

    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.

    • Thrombectomy
    • Stroke

    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request from corresponding author.

    https://doi.org/10.1136/neurintsurg-2022-018715

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      Data availability statement

      Data are available upon reasonable request. Data are available upon reasonable request from corresponding author.

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      Footnotes

      • Twitter @gboulouis, @jildazz, @RaoulPop25

      • Collaborators Endovascular Treatment in Ischemic Stroke (ETIS) Investigators. Rothschild Foundation: Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Hebert Solène, Mikael Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy.Foch Hospital: Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, Bertrand Lapergue, David WeisenburgerLile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier. CHU Bordeaux: Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon. CHU Nantes: Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre. CHRU-Nancy: Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Gérard Audibert, Marcela Voicu, Lionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar, Pauline Bourst, Valérie Georges, Sarah Guy, Fatiha Bechiri. CHU Limoges: Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard. CHRU Gui de Chauliac: Vincent Costalat, Caroline Arquizan, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst. CHU Rennes: Francois Eugene, Stéphane Vannier, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault. CHU Pitié-Salpétrière: Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos. CHU Kremlin-Bicêtre: Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti, Mariana Sarov, Nicolas Legris.Hôpital Saint Anne: Olivier Naggara, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Guillaume Turc, Pierre Seners, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun. CHU Toulouse: Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall. CHU Caen: Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti. CHU Brest: Serge Timsit, Jean-Christophe Gentric, Julien Ognard, Francois Mathias Merrien. CHU Rouen: Ozlem Ozku Wermester, Evelyne Massardier, Chrysanthi Papagiannaki, Aude Triquenot, Margeaux Lefebvre. CH Bayonne: Frédéric Bourdain, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue. CHU Strasbourg: Valérie Wolff, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Raoul Pop, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran. CH Vannes: Anthony Le Bras, Sarah Evain, Arnaud Le Guen.

      • Contributors Dr de Havenon is responsible for all aspects of the study. Dr. Finitsis conducted the statistical analysis. Dr. Gory conceived of the study and assisted with drafting/editing of the manuscript. All other authors contributed to the drafting/editing and critical revisions of the manuscript, as well as data gathering.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.