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Original research
Endovascular therapy of acute vertebrobasilar occlusions: influence of first-line strategy in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry
  1. Imen Bekri1,
  2. Stefanos Finitsis2,
  3. Silvia Pizzuto3,
  4. Benjamin Maier4,5,
  5. Michel Piotin5,
  6. Omer F Eker6,
  7. Gaultier Marnat7,
  8. Igor Sibon8,
  9. Cyril Dargazanli9,
  10. Romain Bourcier10,
  11. Bertrand Lapergue11,
  12. Raoul Pop12,
  13. Jildaz Caroff13,
  14. Benjamin Gory14,
  15. Fernando Pico15,
  16. Arturo Consoli3,16
  17. on behalf of the ETIS Registry investigators
    1. 1Department of Neurology, Centre Hospitalier de Versailles, Versailles, Île-de-France, France
    2. 2Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Central Macedonia, Greece
    3. 3Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France
    4. 4Department of Neurology, Saint Anne Hospital Centre; Université Paris Cité, Paris, France
    5. 5Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
    6. 6Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
    7. 7Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    8. 8Department of Neurology, Bordeaux Unviersity Hospital, Bordeaux, France
    9. 9Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, Occitanie, France
    10. 10Neuroradiology, Université de Nantes, CHU Nantes, Neuroradiologie Diagnostique et Interventionnelle, Institut du thorax, Nantes, France
    11. 11Department of Neurology and Stroke Center, Hospital Foch, Suresnes, Île-de-France, France
    12. 12Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
    13. 13Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
    14. 14Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
    15. 15Department of Vascular Neurology, Centre Hospitalier de Versailles, Versailles, France
    16. 16UFR Simon Veil Santé, University of Versailles Saint-Quentine-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
    1. Correspondence to Dr Arturo Consoli, Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes 92150, France; onemed21{at}


    Background The choice of the first-line technique in vertebrobasilar occlusions (VBOs) remains challenging. We aimed to report outcomes in a large cohort of patients and to compare the efficacy and safety of contact aspiration (CA) and combined technique (CoT) as a first-line endovascular technique in patients with acute VBOs.

    Methods We retrospectively analyzed clinical and neuroradiological data of patients with VBOs from the prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and August 2023. The primary outcome was the first pass effect (FPE) rate, whereas modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 and 2c-3, number of passes, need for rescue strategy, modified Rankin Scale (mRS) 0–2, mortality, and symptomatic intracranial hemorrhage (sICH) were secondary outcomes. We performed univariate and multivariate analyses to investigate differences between the two groups.

    Results Among the 583 included patients (mean age 66.2 years, median National Institutes of Health Stroke Scale (NIHSS) 13, median posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) 8), 393 were treated with CA alone and 190 with CoT. Procedures performed with CA were shorter compared with CoT (28 vs 47 min, P<0.0001); however, no differences were observed in terms of FPE (CA 43.3% vs CoT 38.4%, P=0.99), and successful final recanalization (mTICI 2b-3, CA 92.4% vs CoT 91.8%, P=0.74) did not differ between the two groups. Functional independence and sICH rates were also similar, whereas mortality was significantly lower in the CA group (34.5% vs 42.9%; OR 1.79, 95% CI 1.03 to 3.11).

    Conclusions We observed no differences in FPE, mTICI 2b-3, sICH, and functional independence between the two study groups. First-line CA was associated with shorter procedures and lower mortality rates than CoT.

    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    • IB and SF are joint first authors.

    • Twitter @BenjaminMaierMD, @RaoulPop25, @jildazz

    • Collaborators Rothschild Foundation: Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean Philippe Desilles, François Delvoye, Stanislas Smajda, Solène Hebert, Mikael Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy. Foch Hospital: Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier. CHU Bordeaux: Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon. CHU Nantes: Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre. CHRU-Nancy: Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Gérard Audibert, Marcela Voicu, Ionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar, Sarah Guy, Valérie Georges, Fatiha Bechiri. CHU Limoges: Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard. CHRU Gui de Chauliac: Vincent Costalat, Caroline Arquizan, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst. CHU Rennes: Quentin Alias, Fakhreddine Boustia, Jean-Christophe Ferre, Hélène Raoult, Jean-Yves Gauvrit, Stéphane Vannier, Maud Guillen, Thomas Ronziere, Veronica Lassalle, Clément Tracol, Cécile Malrain, Soizic Boinet. CHU Pitié-Salpêtrière: Frédéric Clarençon, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson, Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos. CHU Kremlin-Bicêtre: Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Olivier Chassin, Laura Venditti, Mariana Sarov, Nicolas Legris. Hôpital Saint-Anne: Olivier Naggara, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Guillaume Turc, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun. CHU Toulouse: Alain Viguier, Christophe Cognard, Anne-Christine Januel, JeanMarc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean-François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall. CHU Caen: Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti. CHU Brest: Serge Timsit, Jean-Christophe Gentric, Julien Ognard, Francois Mathias Merrien. CHU Rouen: Ozlem Ozku Wermester, Evelyne Massardier, Chrysanthi Papagiannaki, Aude Triquenot, Margeaux Lefebvre. CH Bayonne: Frédéric Bourdain, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue. CHU Strasbourg: Valérie Wolff, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Remy Beaujeux, Dan Mihoc, MonicaManisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran. CH Vannes: Anthony Le Bras, Sarah Evain, Arnaud Le Guen.

    • Contributors AC, FP, BG, BL participated on the study design and conception. BM, SP, IB, CD, BL participated on data collection. MP, GM, OFE, IS, CD, RB, RP, JC made critical revisions and supervision on drafting. IB, SF and SP were in charge of manuscript drafting. All the authors had access to and agreed on the final version of the manuscript.

    • 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 JC is a consultant for Balt, Medtronic, Stryker. GM is a consultant for Balt USA, Bracco Imaging, Johnson&Johnson Medical Devices&Diagnostics Group, Medtronic, MicroVention, Phenox, Stryker.

    • 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.