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Original research
Frontline thrombectomy strategy and outcome in acute basilar artery occlusion
  1. Mohamed Abdelrady1,2,
  2. Julien Ognard2,
  3. Federico Cagnazzo1,
  4. Imad Derraz1,
  5. Pierre-Henri Lefevre1,
  6. Carlos Riquelme1,
  7. Gregory Gascou1,
  8. Caroline Arquizan3,
  9. Cyril Dargazanli1,
  10. Mourad Cheddad El Aouni2,
  11. Douraied Ben Salem4,
  12. Isabelle Mourand3,
  13. Vincent Costalat1,
  14. Jean Christophe Gentric2
  15. on behalf of RAMBO (Revascularization via Aspiration or Mechanical thrombectomy in Basilar Occlusion)
    1. 1Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
    2. 2Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
    3. 3Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
    4. 4Diagnostic neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
    1. Correspondence to Dr Mohamed Abdelrady, Interventional Neuroradiology, Hôpital Gui de Chauliac Pôle Neurosciences tête et cou, Montpellier 34295, Languedoc-Roussillon Midi, France; mmabdelrady{at}gmail.com

    Abstract

    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.

    • thrombectomy
    • angioplasty
    • catheter
    • device
    • posterior fossa

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • 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.

    • 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.