title: A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study.
abstract: OBJECTIVE Contrary to acute ischemic stroke involving the anterior circulation, no randomized trial has yet demonstrated the safety and effectiveness of endovascular management in acute basilar artery occlusion (BAO). Recently developed thrombectomy devices, such as stentrievers and aspiration systems, have helped in improving the endovascular management of acute ischemic stroke. The authors sought to assess the impact of these devices in the endovascular treatment of acute BAO. METHODS A retrospective analysis of 34 consecutive patients treated in Pitié-Salpêtrière Hospital for acute BAO was carried out. All patients had undergone an endovascular procedure. In addition to the global results in terms of safety and effectiveness (recanalization rate and 3-month clinical outcome based on the modified Rankin Scale [mRS]), the authors aimed to determine if the patients treated with the most recently developed devices (i.e., the Solitaire stentriever or the ADAPT catheter) had better angiographic and clinical outcomes than those treated with older endovascular strategies. RESULTS The overall successful recanalization rate (thrombolysis in cerebral infarction score 2b-3) was 50% (17 of 34 patients). A good clinical outcome (mRS score 0-2 at 3-month follow-up) was achieved in 11 (32.3%) of 34 patients. The mortality rate at 3-month follow-up was 29.4% (10 of 34 patients). Patients treated with the Solitaire stentriever and the ADAPT catheter had a higher recanalization rate (12 [92.3%] of 13 patients vs 5 [23.8%] of 21 patients, p = 0.0002) and a shorter mean (± SD) procedure duration (88 ± 31 minutes vs 126 ± 58 minutes, p = 0.04) than patients treated with older devices. CONCLUSIONS The latest devices have improved the effectiveness of mechanical thrombectomy in acute BAO. Their use in further studies may help demonstrate a benefit in the endovascular management of acute BAO.
authors.affiliation: Departments of 1 Interventional Neuroradiology.
authors.forename: Robert
authors.initials: R
authors.lastname: Fahed
authors.affiliation: Departments of 1 Interventional Neuroradiology.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Maria
authors.affiliation: Vascular Neurology, and.|Paris VI University, Pierre et Marie Curie; and.|Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM, Paris, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Rosso
authors.affiliation: Departments of 1 Interventional Neuroradiology.
authors.forename: Nader
authors.initials: N
authors.lastname: Sourour
authors.affiliation: Anesthesiology, Pitié-Salpêtrière Hospital.|Paris VI University, Pierre et Marie Curie; and.
authors.forename: Vincent
authors.initials: V
authors.lastname: Degos
authors.affiliation: Vascular Neurology, and.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Deltour
authors.affiliation: Vascular Neurology, and.|Paris VI University, Pierre et Marie Curie; and.
authors.forename: Flore
authors.initials: F
authors.lastname: Baronnet-Chauvet
authors.affiliation: Vascular Neurology, and.
authors.forename: Anne
authors.initials: A
authors.lastname: Léger
authors.affiliation: Vascular Neurology, and.
authors.forename: Sophie
authors.initials: S
authors.lastname: Crozier
authors.affiliation: Departments of 1 Interventional Neuroradiology.|Paris VI University, Pierre et Marie Curie; and.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gabrieli
authors.affiliation: Vascular Neurology, and.|Paris VI University, Pierre et Marie Curie; and.|Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Samson
authors.affiliation: Departments of 1 Interventional Neuroradiology.|Paris VI University, Pierre et Marie Curie; and.
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
authors.affiliation: Departments of 1 Interventional Neuroradiology.|Paris VI University, Pierre et Marie Curie; and.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
mesh_terms: D001488:Basilar Artery; D002545:Brain Ischemia; D057510:Endovascular Procedures; D006801:Humans; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke; D017131:Thrombectomy; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency
keywords: BAO = basilar artery occlusion; CTA = CT angiography; DSA = digital subtraction angiography; DWI = diffusion-weighted imaging; DWI-pc-ASPECTS = DWI–posterior circulation–Alberta stroke program early CT score; IQR = interquartile range; IV = intravenous; MT = mechanical thrombectomy; NIHSS = National Institutes of Health Stroke Scale; RCT = randomized controlled trial; TICI = thrombolysis in cerebral infarction; TOAST = Trial of Org 10172 in Acute Stroke Treatment; VA = vertebral artery; basilar artery occlusion; endovascular; mRS = modified Rankin Scale; stent retriever; thrombectomy; vascular disorders