In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • 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.

    References: References 1. Lindsberg PJ, Sairanen T, Strbian D, Kaste M. Current treatment of basilar artery occlusion. Ann N Y Acad Sci. 2012;1268:35-44. 2. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10:1002-1014. 3. Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988;19:1216-1222. 4. Lindsberg PJ, Soinne L, Roine RO, Tatlisumak T. Options for recanalization therapy in basilar artery occlusion. Stroke. 2005;36:203-204. 5. Wijdicks EF, Nichols DA, Thielen KR, Fulgham JR, Brown RD, Jr., Meissner I, et al. Intra-arterial thrombolysis in acute basilar artery thromboembolism: the initial Mayo Clinic experience. Mayo Clin Proc. 1997;72:1005-1013. 6. Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke. 2006;37:922-928. 7. Brekenfeld C, Schroth G, Mattle HP, Do DD, Remonda L, Mordasini P, et al. Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment. Stroke. 2009;40:847-852. 8. Levy EI, Siddiqui AH, Crumlish A, Snyder KV, Hauck EF, Fiorella DJ, et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke). Stroke. 2009;40:3552-3556. 9. Webb S, Yashar P, Kan P, Siddiqui AH, Hopkins LN, Levy EI. Treatment and outcomes of acute intracranial vertebrobasilar artery occlusion: one institution's experience. J Neurosurg. 2012;116:952-960. 10. Zaidat OO, Wolfe T, Hussain SI, Lynch JR, Gupta R, Delap J, et al. Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke. 2008;39:2392-2395. 11. Bergui M, Stura G, Daniele D, Cerrato P, Berardino M, Bradac GB. Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. Stroke. 2006;37:145-150. 12. Clarencon F, Blanc R, Gallas S, Hosseini H, Gaston A. Thrombectomy for acute basilar artery occlusion by using double Merci retriever devices and bilateral temporary vertebral artery flow reversal. Technical note. J Neurosurg. 2009;111:53-56. 13. Broussalis E, Trinka E, Hitzl W, Wallner A, Chroust V, Killer-Oberpfalzer M. Comparison of stent-retriever devices versus the Merci retriever for endovascular treatment of acute stroke. AJNR Am J Neuroradiol. 2013;34:366-372. 14. Snyder KV, Mokin M, Bates VE. Neurologic applications of whole-brain volumetric multidetector computed tomography. Neurol Clin. 2014;32:237-251. 15. Espinosa de Rueda M, Parrilla G, Zamarro J, Garcia-Villalba B, Hernandez F, Moreno A. Treatment of acute vertebrobasilar occlusion using thrombectomy with stent retrievers: initial experience with 18 patients. AJNR Am J Neuroradiol. 2013;34:1044-1048. 16. Mordasini P, Brekenfeld C, Byrne JV, Fischer U, Arnold M, Heldner MR, et al. Technical feasibility and application of mechanical thrombectomy with the Solitaire FR Revascularization Device in acute basilar artery occlusion. AJNR Am J Neuroradiol. 2013;34:159-163. 17. Mourand I, Machi P, Milhaud D, Picot MC, Lobotesis K, Arquizan C, et al. Mechanical thrombectomy with the Solitaire device in acute basilar artery occlusion. J Neurointerv Surg. 2014;6:200-204. 18. Pfefferkorn T, Mayer TE, Opherk C, Peters N, Straube A, Pfister HW, et al. Staged escalation therapy in acute basilar artery occlusion: intravenous thrombolysis and on-demand consecutive endovascular mechanical thrombectomy: preliminary experience in 16 patients. Stroke. 2008;39:1496-1500. 19. Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J, et al. Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke. 2005;36:1160-1165. 20. Sarikaya H, Arnold M, Engelter ST, Lyrer PA, Mattle HP, Georgiadis D, et al. Outcomes of intravenous thrombolysis in posterior versus anterior circulation stroke. Stroke. 2011;42:2498-2502. 21. Lutsep HL, Rymer MM, Nesbit GM. Vertebrobasilar revascularization rates and outcomes in the MERCI and multi-MERCI trials. J Stroke Cerebrovasc Dis. 2008;17:55-57. 22. Baek JM, Yoon W, Kim SK, Jung MY, Park MS, Kim JT, et al. Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset. AJNR Am J Neuroradiol. 2014;35:989-993. 23. Dorn F, Stehle S, Lockau H, Zimmer C, Liebig T. Endovascular treatment of acute intracerebral artery occlusions with the solitaire stent: single-centre experience with 108 recanalization procedures. Cerebrovasc Dis. 2012;34:70-77. 24. Mohlenbruch M, Stampfl S, Behrens L, Herweh C, Rohde S, Bendszus M, et al. Mechanical thrombectomy with stent retrievers in acute basilar artery occlusion. AJNR Am J Neuroradiol. 2014;35:959-964. 25. Eckert B, Kucinski T, Pfeiffer G, Groden C, Zeumer H. Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. Cerebrovasc Dis. 2002;14:42-50. 26. Kashiwagi J, Kiyosue H, Hori Y, Okahara M, Tanoue S, Sagara Y, et al. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty. Neuroradiology. 2010;52:361-370.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy