title: Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion-a retrospective single center experience.
abstract: BACKGROUND
  The study aimed to compare efficacy and safety of aspiration thrombectomy (AT) to stentriever thrombectomy (SRT) in patients with basilar artery (BA) occlusion (BAO).
  
  
  METHODS
  We retrospectively included patients with the following characteristics: acute BAO or occlusion of the intracranial vertebral artery (ICVA) and endovascular therapy (EVT) with stentriever (SRT) or aspiration thrombectomy (AT). Additional extra- but not intracranial EVT and intravenous thrombolysis (IVT) were allowed.
  
  
  RESULTS
  Between January 2013 and April 2016, 33 patients fulfilled the criteria (13 treated with SRT, 20 with AT). Prior to EVT, 23 (70%) patients received IVT. The proximal intracranial occlusion was ICVA in 2 patients, proximal BA in 5 patients, middle BA in 20 patients, and distal BA in 6 patients. Mean time to treatment was 334 min (95% CI 276-391 min). Procedure duration differed significantly (p = 0.002) as follows: 97 min with SRT (95% CI 69-124 min) and 55 min with AT (95% CI 43-66 min). Recanalization (arterial occlusive lesion (AOL) 2/3) was achieved in 26 patients (79%). Complete recanalization (AOL 3) happened more often with AT (75% (95% CI 65-85%)) compared to SRT (46% (95% CI 32-60%)). Conversion rate 6% (two patients). Hemorrhages occurred in 12 (36%) patients, periprocedural complications in eight (three dissections, five embolizations to new territory) (no group difference). Ten patients (30%) had a favorable outcome (mRS ≤3) at discharge; mortality rate was 24% (eight deaths) (no group difference).
  
  
  CONCLUSIONS
  In primarily embolic BAO, aspiration thrombectomy was faster, effective and not detrimental to outcome as compared to stentriever thrombectomy. Thus, it may be justified to use aspiration thrombectomy as first-line treatment in these patients.
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany. johannes.gerber@uniklinikum-dresden.de.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Gerber
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Daubner
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kaiser
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Kay
authors.initials: K
authors.lastname: Engellandt
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Haedrich
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Mueller
authors.affiliation: Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linn
authors.affiliation: Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany.
authors.forename: Andrij
authors.initials: A
authors.lastname: Abramyuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D001488:Basilar Artery; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D020878:Device Removal; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000628:therapy*; D013396:Suction / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Aspiration thrombectomy; Basilar artery occlusion; Endovascular treatment; Stent retriever; Stroke