Journal Article

Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion

Pangon, Nicolas, Bernady, Patricia, Gauberti, Maxime, Wolff, Valerie, Lauer, Valerie, Finitsis, Stephanos Nikolaos, Fahed, Robert, Venditti, Laura, Paya, Christophe, Calviere, Lionel, Bellanger, Guillaume, Pottecher, Julien, Merrien, Francois Mathias, Liao, Liang, Schiphorst, Adrien ter, Veunac, Louis, Dessilles, Jean-Philippe, Maacha, Malek Ben, Cosnard, Alexandre, Barreau, Xavier, Maurice, Axelle, Pierre-Paul, Irene, Gascou, Grégory, Albucher, Jean François, Manisor, Monica, Darcourt, Jean, Wang, Adrien, Papagiannaki, Chrisanthi, Timsit, Serge, Douarinou, Marian, Chassin, Olivier, Braun, Marc, Pop, Raoul, Eugene, Francois, Liegey, Jean-Sebastien, Tabarna, Adriana, Domigo, Valérie, Macian, Francisco, Evain, Sarah, Podar, Iona, Maïer, Benjamin, Manchon, Eric, Gauvrit, Jean-Yves, Alexandre, Pierre-Louis, Lacour, Jean-Christophe, Guy, Sarah, Costalat, Vincent, Yger, Mathon, Bras, Anthony Le, Bourcier, Romain, Boulouis, Grégoire, Chamaraux-Tran, Thiên-Nga, Gory, Benjamin, Touze, Emmanuel, Taylor, Guillaume, Boulanger, Marion, Lagoarde-Segot, Laurent, Guen, Arnaud Le, Lefèvre, Pierre-Henri, Baronnet, Flor

2023

Overview

BackgroundThe number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes.MethodsWe used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0–3 at 90 days. We fit mixed multiple regression models, with center as a random effect.ResultsWe included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901).ConclusionsWe found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Journals,BMJ Publishing Group
• Subject: Arterial Occlusive Diseases / Arterial Occlusive Diseases - diagnostic imaging / Arterial Occlusive Diseases - surgery / Basilar Artery / Basilar Artery - diagnostic imaging / Basilar Artery - surgery / Cerebral Infarction / Cerebral Infarction - etiology / Endovascular Procedures / Endovascular Procedures - methods / Human health sciences / Humans / Ischemic Stroke / Ischemic Stroke - etiology / Life Sciences / Neurologie / Neurology / Neurology (clinical) / Neurons and Cognition / Patients / Prospective Studies / Regression analysis / Reperfusion / Retrospective Studies / Sciences de la santé humaine / Stroke / Stroke - diagnostic imaging / Stroke - surgery / Surgery / Thrombectomy / Thrombectomy - methods / Thrombolytic drugs / Treatment Outcome / Variables / Veins & arteries