Comparison of demographics, cerebrovascular risk factors, and procedural perspectives between the endovascular thrombectomy techniques in 128 patients with acute basilar artery occlusion
| Total cohort (n=128) | Single approach | Dual approach | P value | |||
| Contact aspiration (CA) (n=33) | Stent retriever (SR) (n=35) | Combined (SR+CA) (n=35) | Switch (n=25) | |||
| Demographics and comorbidities | ||||||
| Age (years) (mean (SD)) | 66.9 (11.8) | 67.5 (11) | 65.97 (13.7) | 68.7 (11) | 64.8 (10.3) | 0.60 |
| Sex (men) (n (%)) | 83 (65) | 19 (58) | 20 (57) | 25 (71) | 19 (76) | 0.29 |
| Diabetes mellitus (n (%)) | 19 (15) | 5 (15) | 3 (9) | 6 (17) | 5 (20) | 0.62 |
| Glucose level* (mmol/l) (median (IQR)) | 7 (6–8.5) | 6.9 (6–9.6) | 6.95 (6–8.2) | 7.3 (5.5–8.5) | 7.8 (6–10.2) | 0.69 |
| Hypertension (n (%)) | 77 (60) | 17 (52) | 23 (66) | 24 (69) | 13 (52) | 0.36 |
| Systolic blood pressure (mean (SD)) | 141 (26) | 136 (24) | 144 (24) | 142 (30) | 143 (23) | 0.63 |
| Diastolic blood pressure (mean (SD)) | 79 (15) | 82 (13) | 78 (17) | 78 (16) | 76 (11) | 0.45 |
| Hypercholesterolemia (n (%)) | 30 (23) | 7 (21) | 9 (26) | 6 (17) | 8 (32) | 0.57 |
| Active smoking (n (%)) | 41 (32) | 8 (24) | 13 (37) | 8 (23) | 12 (48) | 0.13 |
| Atrial fibrillation (n (%)) | 27 (21) | 8 (24) | 8 (23) | 8 (23) | 3 (12) | 0.66 |
| Cerebrovascular accident (n (%)) | 23 (18) | 10 (30) | 6 (17) | 4 (11) | 3 (12) | 0.17 |
| Antiplatelets (n (%)) | 35 (27) | 7 (21) | 14 (40) | 10 (29) | 4 (16) | 0.17 |
| Anticoagulants (n (%)) | 17 (13) | 4 (12) | 1 (3) | 8 (23) | 4 (16) | 0.08 |
| Clinicoimaging features | ||||||
| Initial NIHSS score (median (IQR)) | 15 (10–25) | 14 (8–19.5) | 18 (12–40) | 13 (9–24) | 17 (9.5–40) | 0.30 |
| Intravenous rt-PA (n (%)) | 46 (36) | 8 (24) | 17 (49) | 10 (29) | 11 (44) | 0.12 |
| Clot location (n (%)) | ||||||
| Intracranial vertebral artery | 14 (11) | 2 (6) | 1 (3) | 5 (14) | 6 (24) | 0.047 |
| Proximal basilar artery | 28 (22) | 9 (27) | 4 (11) | 7 (20) | 8 (32) | 0.22 |
| Mid basilar artery | 29 (23) | 7 (21) | 14 (40) | 6 (17) | 2 (8) | 0.02 |
| Distal basilar artery | 57 (44) | 15 (45) | 16 (46) | 17 (49) | 9 (36) | 0.80 |
| PC-CS (median (IQR)) | 5 (4–6) | 5 (4–6) | 5 (4–7) | 5 (4–6) | 5 (2.5–6) | 0.12 |
| Etiology (n (%)) | ||||||
| Emboli | 74 (59) | 26 (79) | 20 (59) | 18 (55) | 8 (32) | 0.004 |
| ICAS | 31 (24) | 3 (9) | 8 (23) | 13 (39) | 9 (36) | 0.04 |
| Tandem | 20 (16) | 4 (12) | 6 (18) | 2 (6) | 8 (32) | 0.04 |
| Time to imaging (min) (median (IQR)) | 243 (150–365) | 314 (203–390) | 250 (150-400) | 185 (110–359) | 177 (112–368) | 0.13 |
| Imaging to puncture (min) (median (IQR)) | 108 (60–224) | 94 (50–263) | 94 (60–213) | 130 (54–222) | 168 (82–222) | 0.28 |
| Puncture to revascularization (min) (median (IQR)) | 50 (26–84) | 25 (18–52) | 45 (27–83) | 56 (33–75) | 89 (56–124) | <0.001 |
| Procedural details | ||||||
| No of passes (median (IQR)) | 1 (1–2) | 1 (1–1) | 1 (1–2) | 1 (1–2) | 3 (2–4) | <0.001 |
| Switch technique (n (%)) | 25 (20) | 20/53 (38) | 4/39 (10) | 1/36 (3) | <0.001 | |
| Rescue maneuver (n (%)) | 25 (20) | 0 (0) | 6 (17) | 9 (26) | 10 (40) | 0.001 |
| FPE (n (%)) | 43 (34) | 15 (45) | 10 (29) | 18 (51) | -- | 0.13 |
| Safety outcome | ||||||
| Distal, collateral embolization (n (%)) | 21 (16) | 4 (12) | 7 (20) | 2 (6) | 8 (32) | 0.04 |
| Subarachnoid hemorrhage (n (%)) | 11 (8)* | 1 (3) | 3 (9) | 3 (9) | 1 (4) | 0.74 |
| Non-symptomatic hemorrhage (n (%)) | 15 (12) | 3 (9) | 9 (26) | 1 (3) | 2 (8) | 0.03 |
| sICH (n (%)) | 6 (5) | 2 (6) | 2 (6) | 2 (6) | 0 (0) | 0.65 |
| Mortality (n (%)) | 49 (38) | 11 (33) | 11 (31) | 17 (49) | 10 (40) | 0.45 |
| Final infarct size, PC-ASPECTS (median (IQR)) | 6 (4–8) | 7 (6–8.75) | 5 (3–8) | 7 (4–8.25) | 6 (3–8) | 0.18 |
*Total frequency of subarachnoid hemorrhage which includes three patients who were excluded because of early microwire perforation. The proportion was calculated from the 140 attempted thrombectomies after excluding 2 patients who underwent spontaneous recanalization (n=1) and primary angioplasty rather than regular thrombectomy (n=1).
BAO, basilar artery occlusion; EVT, endovascular thrombectomy; FPE, first pass effect; ICAS, intracranial atherosclerotic stenosis; NIHSS, National Institutes of Health Stroke Scale; PC-ASPECTS, posterior circulation Alberta Stroke Programme Early CT Score; PC-CS, posterior circulation collateral score; rt-PA, recombinant tissue plasminogen activator; sICH, symptomatic intracranial hemorrhage.