RT Journal Article
SR Electronic
T1 Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1174
OP 1180
DO 10.1136/neurintsurg-2018-014516
VO 11
IS 12
A1 Meinel, Thomas Raphael
A1 Kaesmacher, Johannes
A1 Chaloulos-Iakovidis, Panagiotis
A1 Panos, Leonidas
A1 Mordasini, Pasquale
A1 Mosimann, Pascal J
A1 Michel, Patrik
A1 Hajdu, Steven
A1 Ribo, Marc
A1 Requena, Manuel
A1 Maegerlein, Christian
A1 Friedrich, Benjamin
A1 Costalat, Vincent
A1 Benali, Amel
A1 Pierot, Laurent
A1 Gawlitza, Matthias
A1 Schaafsma, Joanna
A1 Pereira, Vitor M
A1 Gralla, Jan
A1 Fischer, Urs
YR 2019
UL http://jnis.bmj.com/content/11/12/1174.abstract
AB Background Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.Objective To compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.Methods In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.Results MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.Conclusions In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.Trial registration number NCT03496064