Stent Retriever-Assisted Mechanical Thrombectomy for Acute Basilar Artery Occlusion: Single US Institution Experience

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Abstract

BACKGROUND:

Acute basilar artery occlusion causes devastating strokes that carry high mortality and morbidity.

OBJECTIVE:

To report the outcomes of mechanical thrombectomy in the posterior circulation with a focus on safety and efficacy of stent retrievers.

METHODS:

We retrospectively reviewed our endovascular database for all patients treated with stent retrievers for posterior circulation stroke between June 2012 and June 2014. Twelve patients were identified. The following data were analyzed: thrombus location, previous stroke or transient ischemic attack, thrombus etiology, comorbidities, time from presentation to initiation of endovascular treatment, time from start of angiography to revascularization, and whether intravenous tissue plasminogen activator was administered pre-thrombectomy. Outcome was considered poor when modified Rankin Scale score was >2.

RESULTS:

Mean patient age was 63.42 years (median, 64.5; range, 28-83 years); 7 were women. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 11 of 12 patients (91.7%). Mean discharge modified Rankin Scale score was 2.3 (median, 2.0; standard deviation 1.96; range, 0-6), with a favorable discharge outcome in 9 of 12 (75%) patients. Two patients died as inpatients. Mean follow-up modified Rankin Scale score was 1.4 (median, 1.00; standard deviation 1.075; range, 0-4). Good outcome was achieved in 9 of 10 (90%) patients at last follow-up (mean follow-up duration, 132.42 days [median, 90.50; standard deviation 80.2; range, 8-378 days]).

CONCLUSION:

Our single-institution study has shown that good clinical outcomes and successful recanalization with acceptable mortality can be achieved with current stent retrievers.

ABBREVIATIONS:

ABAO, acute basilar artery occlusion

ABBREVIATIONS:

BA, basilar artery

ABBREVIATIONS:

CT, computed tomographic

ABBREVIATIONS:

IV, intravenous

ABBREVIATIONS:

mRS, modified Rankin Scale

ABBREVIATIONS:

NIHSS, National Institutes of Health Stroke Scale

ABBREVIATIONS:

TICI, thrombolysis in cerebral infarction

ABBREVIATIONS:

tPA, tissue plasminogen activator

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