Mechanical Thrombectomy for Basilar Artery Occlusion

Journal of the American Heart Association. 2019

The efficacy of mechanical thrombectomy for emergent large vessel occlusion of the anterior cerebral circulation has been clearly shown through multiple international clinical trials.  The clinical benefit of thrombectomy in the posterior circulation (PC) is less well understood, with few clear predictors of clinical outcome.  In this paper Guillaume et al. studied 95 patients with basilar artery occlusion who achieved successful reperfusion (defined as mTICI 2b or 3).  Data from these patients were collected prospectively from 3 comprehensive stroke centers over 7 years and include pre- and post-treatment clinical and imaging findings and workflow times.  A good clinical outcome, defined as mRS 0-2 at 90 days post-treatment, was achieved in 39.4% of successfully reperfused patients with a DWI PC ASPECTS < 8 and 53.6% with PC ASPECTS ≥ 8.  In examining the effect of workflow times on outcome, the authors demonstrated a significant dependence of imaging-to-reperfusion time on the PC-ASPECTS < 8 cohort, with a dramatic decrease in good outcome probability over time.   This time relationship was not seen in the pc-ASPECTS ≥ 8 group.  The authors posit that the “fast-progressor” patients are those that have less compensatory capacity due to inadequate collaterals. For these patients, it is critical to achieve fast and efficient thrombectomies. 

Stephen Grupke, MD
Lexington, KY