Background Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO).
Purpose To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO.
Methods Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c–3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0–2.
Results Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate.
Conclusion Among BAO patients, the combined technique effectively contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.
- posterior fossa
Data availability statement
Data are available upon reasonable request.
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Collaborators RAMBO group investigators: Mohamed Abdelrady, Imad Derraz, Pierre-Henri Lefevre, Federico Cagnazzo, Carlos Riquelme, Gregory Gascou, Mehdi Mahmoudi, Lucas Corti, Nicolas Gaillard, Mourad Cheddad El Aouni, Douraied Ben Salem, Cyril Dargazanli, Julien Ognard, Isabelle Mourand, Caroline Arquizan, Jean-Christophe Gentric, and Vincent Costalat.
Contributors Study design: MA, ID, and JO. Acquisition, analysis, or interpretation of the data: all authors. Drafting of the manuscript: MA, JO, ID, P-HL, FC, GG, and CD. Statistical analysis: MA and JO. Supervision: VC, JC-G, IM, and CA. Guarantor: MA, JO, VC, JC-G.
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.
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