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  • Stent Retriever-assisted Mechanical Thrombectomy for Acute Basilar Artery Occlusion: Single U.S. Institution Experience

    Final Number:

    Ashish Sonig MD MS MCh neurosurgery; Chandan Krishna MD; Sabareesh Kumar Natarajan MD MBBS MS; Jian Min Liu; L. Nelson Hopkins MD; Kenneth V. Snyder MD, PhD; Elad I. Levy MD, FACS, FAHA, FAANS; Adnan Hussain Siddiqui MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Acute basilar artery occlusion (ABAO) causes devastating strokes that carry high mortality and morbidity. Recent trials (MR CLEAN, EXTENDI-IA, swift prime and ESCAPE) has establish the superiority of intra-arterial treatment of anterior circulation stroke.We 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 (mRS) 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 mRS score was 2.3 (median 2.0; SD 1.96; range 0–6), with a favorable discharge outcome in 9 of 12 (75%) patients. Two patients died as inpatients. Mean follow-up mRS score was 1.4 (median 1.00; SD 1.075; range 0–4). Good outcome was seen in 9 of 10 (90%) patients at last follow-up (mean follow-up duration, 132.42 days [median 90.50, SD 80.2; range 8-378 days]).

    Conclusions: Our study has shown that by reducing procedure time and avoiding thromboembolic complications, good clinical outcomes and good recanalization with reduced mortality can be achieved with current stent retrievers (Solitaire FR and Trevo). These results leave room for large multicenter trials to further evaluate the scope of endovascular therapy in patients with posterior circulation stroke

    Patient Care: 1. Till now , intra-arterial therapy for acute posterior circulation stroke carried high mortality.Our study has shown that decreased mortality and morbidity could be achieved.

    Learning Objectives: 1. Better results can be achieved by the use of stent retrievers in acute posterior circulation stroke. 2. Decrease recanalization time, translated into bette outcomes and lesser mortality.

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