Mechanical thrombectomy in basilar artery thrombosis: technical advances and safety in a 10-year experience.
OBJECTIVE
Multiple endovascular devices have been used for mechanical thrombectomy (MT) in basilar artery occlusion (BAO) for >10 years. Based on a single-center experience during the course of one decade, we present data on safety and efficacy of previous MT devices compared with modern stent retriever and suction thrombectomy.


METHODS
Eighty-one patients (29 women, 52 men, mean age 61.5 years, range 17-90) with angiographically confirmed BAO that had been treated by MT between 2001 and 2011 were retrospectively evaluated. Patients in group 1 (n = 60) had been treated between 2001 and 2008 with different devices available at that time. Patients in group 2 (n = 21) had been treated by modern stent retriever or local suction devices between 2008 and 2011. Recanalization rate, needle to recanalization time, procedure-related complications, and distal embolization of thrombotic material were recorded and compared.


RESULTS
Recanalization rates of 95% were high in both groups. Procedure-related dissection (n = 5) and subarachnoid hemorrhage (n = 9) occurred in group 1 but not in group 2 (p < 0.016). Needle-to-recanalization time was less than half in group 2 compared with group 1 (54.6 vs. 132.3 min, p < 0.01). Frequency of distal embolization was comparable in both groups (47%).


CONCLUSIONS
High recanalization rates have been achieved since the introduction of MT in BAO. However, modern stent retriever and suction devices allow for safer and more rapid recanalization compared with previous MT devices.
Department of Neuroradiology, Klinikum Grosshadern, University of Munich, Marchioninistr. 15, 81377, Munich, Germany, gunther.fesl@med.uni-muenchen.de.
Gunther
G
Fesl
Markus
M
Holtmannspoetter
Maximilian
M
Patzig
Thomas E
TE
Mayer
Thomas
T
Pfefferkorn
Hartmut
H
Brueckmann
Gernot
G
Schulte-Altedorneburg
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*