Intra-Arterial Treatment for Patients with Severe Acute Vertebrobasilar Occlusion: A Single-Center Retrospective Study

Basilar artery stenting in hyperacute stroke: A systematic review of published cases

BACKGROUND AND PURPOSE

Basilar artery stenting is a rescue therapy in the management of hyperacute stroke. Published data on efficacy and safety are limited.

METHODS

A systematic review of published studies was performed in accordance with PRISMA guidelines. Inclusion criteria were adult patients with ischemic stroke with permanent basilar artery stent placement within 48 h of onset. Data were extracted by two independent reviewers. Additional cases from our institution were identified via a local stroke registry.

RESULTS

Of 212 screened articles, patient-level data was reported in 35 studies (87 individuals) and six additional patients were included from our registry. Patients (n = 93, 63 % male; median age 64) most often presented with mid-basilar occlusion (52 %) and 76 % received treatment within 12 hours of onset. Favorable angiographic results occurred in 67 %. The final modified Rankin Scale score (mRS) was 0-3 for 56 % of patients; mortality was 29 %. Those with complete flow post-procedure were more likely to have a final mRS of 0-3 (p = 0.05).

CONCLUSIONS

In 93 cases of basilar stenting in hyperacute stroke, favourable angiographic and functional outcomes were reported in 67 % and 56 % of patients, respectively. International multicenter registries are required to establish benefit and identify patient and technical factors that predict favorable outcomes.

Predictors of Functional Outcome and Mortality in Endovascular Treatment for Acute Basilar Artery Occlusion: A Single-Centre Experience

Background and Purpose: The objective of this study was to identify prognostic factors of endovascular treatment in patients with acute basilar artery occlusion and add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion. Materials and Methods: We reviewed the data of 101 patients with acute basilar artery occlusion receiving endovascular treatment from January 2013 to September 2019. Baseline characteristics and outcomes were evaluated. A favourable functional outcome was defined as a mRS of 0 to 2 assessed at the 3 month follow-up. The association of clinical and procedural characteristics with the functional outcome and mortality was assessed. Results: The study population consisted of 101 patients: 83 males and 18 females. Successful recanalization was achieved in 99 patients (97.1%). A favourable clinical outcome was observed in 50 patients (49.5%), and the overall mortality rate was 26.7%. A favourable outcome was significantly associated with NIHSS score at admission and lung infection. Mortality was associated with NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, and diabetes mellitus. Conclusions: This study suggested that NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, diabetes mellitus, and lung infection can predict the functional outcome and mortality. These initial results add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion and need to be confirmed by further prospective studies.