Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre
1Stroke Unit, Department of Neurology. Hospital Universitario Miguel Servet, Zaragoza, Spain
2Interventional Neuroradiology Unit, Department of Radiology. Hospital Universitario Miguel Servet, Zaragoza, Spain
3Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
4Department of Anaesthesia, Hospital Universitario Miguel Servet, Zaragoza, Spain
DOI: 10.22514/sv.2021.038 Vol.17,Issue 4,July 2021 pp.125-131
Submitted: 08 January 2021 Accepted: 01 February 2021
Published: 08 July 2021
Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation.
Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared.
Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01).
Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.
Mechanical thrombectomy; Acute stroke; Basilar artery occlusion; Aragón; Posterior circulation; General anaesthesia
Ignacio Saldaña-Inda,Herbert Tejada-Meza,Alberto Sainz-Pardo,Cristina Moreno-Loscertales,Javier Marta-Moreno. Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre. Signa Vitae. 2021. 17(4);125-131.
 Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019; 18: 439-458.
 Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. The Lancet Neurology. 2011; 10: 1002-1014.
 Phan K, Phan S, Huo YR, Jia F, Mortimer A. Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis. Journal of NeuroInterventional Surgery. 2016; 8: 1107-1115.
 Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet. 2016; 387: 1723-1731.
 Weber R, Minnerup J, Nordmeyer H, Eyding J, Krogias C, Hadisurya J, et al. Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry. European Journal of Neurology. 2019; 26: 299-305.
 Du H, Tong X, Sun X, Shi Z, Liu B, Gao F, et al. Effect of anesthesia strategy during endovascular therapy on 90-day outcomes in acute basilar artery occlusion: a retrospective observational study. BMC Neurology. 2020; 20: 398.
 Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovascular Diseases. 2009; 27: 493- 501.
 Beltrán Rodríguez I, Tejada García J, Durán Borrella O, Rodrigo Stevens G, García Vieitez JJ. Ictus vertebrobasilar: registro de tiempos de asistencia y factores relacionados con la atención precoz. Revista De Neurología. 2020; 71: 326-334. (In Spanish)
 Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Mosimann PJ, et al. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. Journal of NeuroInterventional Surgery. 2019; 11: 1174-1180.
 Walker M. What is your threshold for treating posterior circulation strokes with thrombectomy and why? Endovascular Today. 2020; 19: 2.
 Zi W, Qiu Z, Wu D, Li F, Liu H, Liu W, et al. Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurology. 2020; 77: 561.
 Scharer S, Posekany A, Greisenegger S. Endovascular treatment in basilar artery occlusion-results from the Austrian endostroke registry. European Stroke Journal. 2019; 4: 578-579.
 Luo G, Mo D, Tong X, Liebeskind DS, Song L, Ma N, et al. Factors asso-ciated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy. World Neurosurgery. 2018; 109: e318-e328.
 Brinjikji W, Pasternak J, Murad MH, Cloft HJ, Welch TL, Kallmes DF, et al. Anesthesia-related outcomes for endovascular stroke revasculariza-tion. Stroke. 2017; 48: 2784-2791.
 Brekenfeld C, Mattle HP, Schroth G. General is better than local anesthesia during endovascular procedures. Stroke. 2010; 41: 2716-2717.
 Löwhagen Hendén P, Rentzos A, Karlsson J, Rosengren L, Leiram B, Sundeman H, et al. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke. Stroke. 2017; 48: 1601-1607.
 Schonewille W. A randomized acute stroke trial of endovascular therapy in acute basilar artery occlusion (BASICS). ESOC European Stroke Organisation. 2020; Available at: https://www.youtube. com/watch?v=6DoW-dENJ9c&feature=emb_title (Accessed: 30 November 2020).
 van der Hoeven EJ, Schonewille WJ, Vos J, Algra A, Audebert HJ, Berge E, et al. The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials. 2013; 14: 200.
 Gory B, Eldesouky I, Sivan-Hoffmann R, Rabilloud M, Ong E, Riva R, et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review. Journal of Neurology, Neurosurgery & Psychiatry. 2016; 87: 520-525.
 Giorgianni A, Biraschi F, Piano M, Mardighian D, Gasparotti R, Frigerio M, et al. Endovascular treatment of acute basilar artery occlusion: Registro Endovascolare Lombardo Occlusione Basilar Artery (RELOBA) Study Group Experience. Journal of Stroke and Cerebrovas-cular Diseases. 2018; 27: 2367-2374.
 ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). Identifier NCT02737189, Basilar Artery Occlusion Chinese Endovascu-lar Trial. 2016; Available at: https://clinicaltrials.gov/ct2/show/record/NCT02737189 (Accessed: 28 December 2020).
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