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Ischemic stroke
Original research
Basilar tip morphology: impact on mechanical thrombectomy for acute distal basilar artery occlusion
  1. Sung Hyun Baik1,
  2. Cheolkyu Jung1,
  3. Byung Moon Kim2,
  4. Dong Joon Kim2
  1. 1 Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
  2. 2 Radiology, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
  1. Correspondence to Dr Dong Joon Kim, Radiology, Yonsei University College of Medicine, Seoul, Korea; djkimmd{at}yuhs.ac

Abstract

Background The morphology of the basilar artery tip (BAT) varies between patients. The morphologic anatomy of the BAT could affect the efficacy of mechanical thrombectomy (MT).

Methods 108 patients with acute distal basilar artery occlusion (dBAO) who underwent MT from January 2013 to December 2021 were retrospectively analyzed. These patients were divided into two groups based on their BAT morphology: those with symmetrical cranial or caudal fusion of the BAT (symmetric group) and those with asymmetrical fusion of the BAT (asymmetric group). Morphological variables and angiographic and clinical outcomes were compared between the two groups.

Results Of the 108 enrolled patients, 42 were in the asymmetric group. Compared with the symmetric group, the asymmetric group had significantly larger BAT diameter (mean 3.5±1.0 mm vs 4.3±1.1 mm, P=0.001) and basilar artery tip/trunk ratio (1.2±0.2 vs 1.7±0.2, P<0.001). The asymmetric group showed a significantly lower rate of complete reperfusion (71.2% vs 40.5%, P=0.002) and first pass effect (FPE) (51.5% vs 21.4%, P=0.002) than the symmetric group. The BAT asymmetry was an independent predictor of failed FPE (OR 0.299, 95% CI 0.098 to 0.918, P=0.035) and failed complete reperfusion (OR 0.275, 95% CI 0.087 to 0.873, P=0.029).

Conclusions The efficacy of MT for dBAO differs according to the anatomic morphology of the BAT. The asymmetric BAT was frequently encountered in dBAO patients and was independently associated with a reduced likelihood of complete reperfusion and FPE.

  • brain
  • thrombectomy
  • stroke
  • angiography

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019841

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors SHB and DJK contributed to concept and design, data acquisition, analysis and interpretation of data, and writing of the initial draft. SHB and DJK contributed to concept and design, data acquisition, interpretation of data, revision of the manuscript for important intellectual content, and supervision. DJK acted as the guarantor. All other authors contributed to concept and design, data acquisition, interpretation of data, and revision of the manuscript for important intellectual content.

    • 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.