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Ischemic stroke
Original research
Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions
  1. María Alonso de Leciñana1,
  2. Michal M Kawiorski1,
  3. Álvaro Ximénez-Carrillo2,
  4. Antonio Cruz-Culebras3,
  5. Andrés García-Pastor4,
  6. Patricia Martínez-Sánchez1,
  7. Andrés Fernández-Prieto1,
  8. José Luis Caniego2,
  9. Jose Carlos Méndez3,
  10. Gustavo Zapata-Wainberg2,
  11. Alicia De Felipe-Mimbrera3,
  12. Fernando Díaz-Otero4,
  13. Gerardo Ruiz-Ares1,
  14. Remedios Frutos1,
  15. Eduardo Bárcena-Ruiz2,
  16. Eduardo Fandiño3,
  17. Begoña Marín1,
  18. José Vivancos2,
  19. Jaime Masjuan3,
  20. Antonio Gil-Nuñez4,
  21. Exuperio Díez-Tejedor1,
  22. Blanca Fuentes1,
  23. Madrid Stroke Network
  1. 1 La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
  2. 2 University Hospital La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain
  3. 3 University Hospital Ramón y Cajal, IRYCIS Universidad de Alcalá, Madrid, Spain
  4. 4 University Hospital Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain
  1. Correspondence to Dr María Alonso de Leciñana, and Blanca Fuentes Department of Neurology and Stroke Center, La Paz University Hospital, Paseo de La Castellana 261, Madrid 28046, Spain; malecinanacases{at}salud.madrid.org; blfuentesg{at}hotmail.com

Abstract

Background and purpose The benefits of mechanical thrombectomy (MT) in basilar artery occlusions (BAO) have not been explored in recent clinical trials. We compared outcomes and procedural complications of MT in BAO with anterior circulation occlusions.

Methods Data from the Madrid Stroke Network multicenter prospective registry were analyzed, including baseline characteristics, procedure times, procedural complications, symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS), and mortality at 3 months.

Results Of 479 patients treated with MT, 52 (11%) had BAO. The onset to reperfusion time lapse was longer in patients with BAO (median (IQR) 385 min (320–540) vs 315 min (240–415), p<0.001), as was the duration of the procedures (100 min (40–130) vs 60 min (39–90), p=0.006). Moreover, the recanalization rate was lower (75% vs 84%, p=0.01). A trend toward more procedural complications was observed in patients with BAO (32% vs 21%, p=0.075). The frequency of SICH was 2% vs 5% (p=0.25). At 3 months, patients with BAO had a lower rate of independence (mRS 0–2) (40% vs 58%, p=0.016) and higher mortality (33% vs 12%, p<0.001). The rate of futile recanalization was 50% in BAO versus 35% in anterior circulation occlusions (p=0.05). Age and duration of the procedure were significant predictors of futile recanalization in BAO.

Conclusions MT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results.

  • Stroke
  • Thrombectomy
  • Complication
  • Intervention

https://doi.org/10.1136/neurintsurg-2016-012797

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    Footnotes

    • Contributors All authors have made substantial contributions to the design of the work; acquisition, analysis, or interpretation of data; drafting the work or revising it critically for important intellectual content. All authors have approved the final version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MAdL: overall responsibility for the manuscript, study concept and design, data acquisition, statistical analyses and interpretation, drafting the manuscript, final critical review of the manuscript. MMK: data acquisition, drafting the manuscript. ÁX-C, AC-C, AG-P, PM-S, GZ-W, AdF, FD-O, GR-A, JV, JM, AG-N and ED-T: data acquisition, revision of the manuscript. AF-P, JLC, JCM, RF, EB-R, EF and BM: radiological data acquisition, revision of the manuscript. BF: overall responsibility for the manuscript, study concept and design, data acquisition, final critical review of the manuscript.

    • Competing interests None declared.

    • Ethics approval Ethics approval was obtained from the ethics committee of University Hospital La Paz.

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