Article Text

Download PDFPDF
Original research
Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors
  1. Raoul Pop1,2,3,
  2. Stephanos Nikolaos Finitsis4,
  3. Caroline Arquizan5,
  4. Mahmoud Elhorany6,
  5. Olivier Naggara7,
  6. Jean Darcourt8,
  7. Frédéric Clarençon9,10,
  8. Sébastien Richard11,
  9. Gaultier Marnat12,
  10. Romain Bourcier13,
  11. Igor Sibon14,
  12. Cyril Dargazanli15,
  13. Raphaël Blanc16,
  14. Bertrand Lapergue17,18,
  15. Arturo Consoli19,20,
  16. Francois Eugene21,
  17. Stephane Vannier22,
  18. Jildaz Caroff23,
  19. Christian Denier24,
  20. Marion Boulanger25,
  21. Maxime Gauberti26,
  22. Aymeric Rouchaud27,28,
  23. Francisco Macian29,
  24. Charlotte Rosso30,
  25. Guillaume Turc31,
  26. Ozlem Ozkul-Wermester32,
  27. Jean François Albucher33,
  28. Anthony Le Bras34,35,
  29. Sarah Evain36,
  30. Valerie Wolff37,
  31. Serge Timsit38,
  32. Jean-Christophe Gentric39,
  33. Frédéric Bourdain40,
  34. Louis Veunac41,
  35. Chrysanthi Papagiannaki42,
  36. Benjamin Gory43,44
  37. the ETIS Registry Investigators
  1. 1Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
  2. 2Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
  3. 3University of Strasbourg, INSERM UMR-S1255, Strasbourg, France
  4. 4Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Central Macedonia, Greece
  5. 5Neurology, Hôpital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France
  6. 6Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
  7. 7Radiology, Saint Anne Hospital Centre, Paris, Île-de-France, France
  8. 8Radiology, Hôpital Purpan, Toulouse, Midi-Pyrénées, France
  9. 9Sorbonne Universite, Paris, Île-de-France, France
  10. 10Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
  11. 11Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
  12. 12Interventional and Diagnostic Neuroradiology, University Hospital Centre Bordeaux, Bordeaux, Aquitaine, France
  13. 13Neuroradiology, Université de Nantes, Nantes, France
  14. 14CHU de Bordeaux, Bordeaux, France
  15. 15Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
  16. 16Departement of interventional neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
  17. 17Neurology, Hopital Foch, Suresnes, Île-de-France, France
  18. 18Université de Versailles Saint-Quentin-en-Yvelines, Versailles, Île-de-France, France
  19. 19Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
  20. 20Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
  21. 21Radiologie, CHU Rennes, Rennes, France
  22. 22Department of Neurology, CHU Rennes, Rennes, Bretagne, France
  23. 23Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
  24. 24Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
  25. 25Department of Neurology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
  26. 26Neuroradiology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
  27. 27Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
  28. 28CNRS, XLIM, UMR 7252, Limoges University, Limoges, Nouvelle-Aquitaine, France
  29. 29Department of Neurology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
  30. 30Urgences cérébro-vasculaires, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
  31. 31Neurology, Groupe Hospitalier Universitaire Paris psychiatrie & neurosciences, Paris, Île-de-France, France
  32. 32Department of Neurology, University Hospital Centre Rouen, Rouen, Normandie, France
  33. 33Neurology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
  34. 34Department of Radiology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
  35. 35CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
  36. 36Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
  37. 37Neurology, University Hospitals Strasbourg, Strasbourg, Alsace, France
  38. 38Department of Neurology, Centre Hospitalier Universitaire de Brest, Brest, Bretagne, France
  39. 39Neuroradiology, Centre Hospitalier Universitaire de Brest, Brest, Bretagne, France
  40. 40Department of Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
  41. 41Department of Neuroradiolology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
  42. 42Interventional Neuroradiology, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
  43. 43Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France
  44. 44IADI, INSERM U1254, Universite de Lorraine, Nancy, Lorraine, France
  1. Correspondence to Dr Raoul Pop, Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France; pop.raoul{at}gmail.com

Abstract

Background Endovascular treatment (EVT) for basilar artery occlusions (BAO) is associated with a higher rate of futile recanalization compared with anterior circulation procedures. We aimed to identify the incidence and predictors of poor clinical outcome despite successful reperfusion in current clinical practice.

Methods We used data from the ETIS (Endovascular Treatment in Ischemic Stroke) registry, a prospective multicenter observational registry of stroke treated with EVT in France. Patients undergoing EVT for acute BAO from January 2014 to May 2019 successfully treated within 8 hours from onset were included. Predictors of 90-day poor outcome (modified Rankin Scale (mRS) 4–6) were researched within patients with successful (modified Thrombolysis In Cerebral Infarction (mTICI 2b-3)) and excellent (mTICI 2c-3) reperfusion.

Results Among 242 patients treated within 8 hours, successful reperfusion was achieved in 195 (80.5%) and excellent reperfusion in 120 (49.5%). Poor outcome was observed in 107 (54.8%) and 60 (50%) patients, respectively. In patients with successful early reperfusion, age, higher initial National Institutes of Health Stroke Scale (NIHSS) score, lower posterior circulation Alberta Stroke Programme Early CT Score (pc-ASPECTS), and absence of prior intravenous thrombolysis were independent predictors of poor outcome. The only treatment factor with an independent predictive value was first-pass mTICI 2b-3 reperfusion (adjusted OR 0.13, 95% CI 0.05 to 0.37, p<0.001). In patients with excellent early reperfusion, independent predictors were age, initial NIHSS score, first-pass mTICI 2c-3 reperfusion, and hemorrhagic transformation on post-interventional imaging.

Conclusions Early successful reperfusion with EVT occurred in 80.5% of patients, and the only treatment-related factor predictive of clinical outcome was first pass mTICI 2b-3 reperfusion. Further research is warranted to identify the optimal techniques and devices associated with first pass reperfusion in the posterior circulation.

  • Stroke
  • Thrombectomy

Data availability statement

Data are available upon reasonable request.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text

Footnotes

  • Twitter @RaoulPop25, @jildazz

  • Collaborators ETIS Registry Investigators: The names of all investigators are listed in the Appendix.

  • Contributors RP, SNF, BG: conception and design of the work, analysis and interpretation of data, drafting the manuscript, final approval of the version to be published, agreement to be accountable for all aspects of the work. CA, ME, ON, JD, FC, SR, GM, RB, IS, CD, RB, BL, AC, FE, SV, JC, CD, MB, MG, AR, FM, CR, GT, OO-W, J-FA, ALB, SE, VW, ST, J-CG, FB, LV, CP: acquisition and interpretation of data, critical revision of the manuscript, final approval of the version to be published, agreement to be accountable for all aspects of the work. Guarantor: BG.

  • 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 FC: Consulting fees from Medtronic, Stryker, Balt. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Penumbra, Balt, Medtronic. Participation on a Data Safety Monitoring Board or Advisory Board – Clinsearch. J-CG: Consulting fees from Medtronic, Stryker, Balt. Support for attending meetings and/or travel from Balt. Participation on a Data Safety Monitoring Board or Advisory Board – Intradys. AR: Consulting fees from Balt. IS: Consulting fees from Sanofi Synthé-Labo, Servier, Boheringer Ingelheim, Astra-Zeneca, Novonordisk, Medtronic. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Sanofi Synthé-Labo, Medtronic, Boheringer Ingelheim, Astra-Zeneca, BMS-Pfizer. GM: Consulting fees from Stryker. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medtronic, Microvention.

  • 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.