title: Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions.
abstract: OBJECTIVE
  The benefits of mechanical thrombectomy (MT) in basilar artery occlusions (BAO) have not been explored in recent clinical trials. We compared outcomes and procedural complications of MT in BAO with anterior circulation occlusions.
  
  
  METHODS
  Data from the Madrid Stroke Network multicenter prospective registry were analyzed, including baseline characteristics, procedure times, procedural complications, symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS), and mortality at 3 months.
  
  
  RESULTS
  Of 479 patients treated with MT, 52 (11%) had BAO. The onset to reperfusion time lapse was longer in patients with BAO (median (IQR) 385 min (320-540) vs 315 min (240-415), p<0.001), as was the duration of the procedures (100 min (40-130) vs 60 min (39-90), p=0.006). Moreover, the recanalization rate was lower (75% vs 84%, p=0.01). A trend toward more procedural complications was observed in patients with BAO (32% vs 21%, p=0.075). The frequency of SICH was 2% vs 5% (p=0.25). At 3 months, patients with BAO had a lower rate of independence (mRS 0-2) (40% vs 58%, p=0.016) and higher mortality (33% vs 12%, p<0.001). The rate of futile recanalization was 50% in BAO versus 35% in anterior circulation occlusions (p=0.05). Age and duration of the procedure were significant predictors of futile recanalization in BAO.
  
  
  CONCLUSIONS
  MT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results.
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: María
authors.identifier: http://orcid.org/0000-0002-4302-6580
authors.initials: M
authors.lastname: Alonso de Leciñana
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Michal M
authors.initials: MM
authors.lastname: Kawiorski
authors.affiliation: University Hospital La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Ximénez-Carrillo
authors.affiliation: University Hospital Ramón y Cajal, IRYCIS Universidad de Alcalá, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cruz-Culebras
authors.affiliation: University Hospital Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: García-Pastor
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Fernández-Prieto
authors.affiliation: University Hospital La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Caniego
authors.affiliation: University Hospital Ramón y Cajal, IRYCIS Universidad de Alcalá, Madrid, Spain.
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Méndez
authors.affiliation: University Hospital La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Zapata-Wainberg
authors.affiliation: University Hospital Ramón y Cajal, IRYCIS Universidad de Alcalá, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: De Felipe-Mimbrera
authors.affiliation: University Hospital Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Díaz-Otero
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Remedios
authors.initials: R
authors.lastname: Frutos
authors.affiliation: University Hospital La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bárcena-Ruiz
authors.affiliation: University Hospital Ramón y Cajal, IRYCIS Universidad de Alcalá, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fandiño
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Marín
authors.affiliation: University Hospital La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Vivancos
authors.affiliation: University Hospital Ramón y Cajal, IRYCIS Universidad de Alcalá, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Masjuan
authors.affiliation: University Hospital Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gil-Nuñez
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Exuperio
authors.initials: E
authors.lastname: Díez-Tejedor
authors.affiliation: La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complication; Intervention; Stroke; Thrombectomy