Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation.

Détails

ID Serval
serval:BIB_A3A69E1AC989
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation.
Périodique
Journal of neurointerventional surgery
Auteur(s)
Meinel T.R., Kaesmacher J., Chaloulos-Iakovidis P., Panos L., Mordasini P., Mosimann P.J., Michel P., Hajdu S., Ribo M., Requena M., Maegerlein C., Friedrich B., Costalat V., Benali A., Pierot L., Gawlitza M., Schaafsma J., Pereira V.M., Gralla J., Fischer U.
ISSN
1759-8486 (Electronic)
ISSN-L
1759-8478
Statut éditorial
Publié
Date de publication
12/2019
Peer-reviewed
Oui
Volume
11
Numéro
12
Pages
1174-1180
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Observational Study
Publication Status: ppublish
Résumé
Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.
To compare patients' outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.
In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.
MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 - 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 - 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.
In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.
NCT03496064.
Mots-clé
Aged, Aged, 80 and over, Basilar Artery/diagnostic imaging, Basilar Artery/surgery, Cerebrovascular Circulation/physiology, Cerebrovascular Disorders/diagnostic imaging, Cerebrovascular Disorders/surgery, Female, Follow-Up Studies, Humans, Male, Middle Aged, Registries, Retrospective Studies, Thrombectomy/adverse effects, Thrombectomy/methods, Treatment Outcome, angiography, intervention, stroke, thrombectomy, thrombolysis
Pubmed
Web of science
Open Access
Oui
Création de la notice
08/07/2019 16:12
Dernière modification de la notice
07/02/2020 6:19
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