Treatment Outcomes of Mechanical Thrombectomy in Patients with Acute Posterior Circulation Stroke

Abstract Objective  The benefits of mechanical thrombectomy (MT) in patients with acute posterior circulation stroke remain unclear. Currently, there is no evidence from randomized control trials to show the safety and effectiveness of MT in patients with posterior circulation stroke. This study was to evaluate the treatment outcomes of MT in posterior circulation stroke patients enrolling in our hospital during 2010 to 2020. Materials and Methods  Between January 2010 and December 2020, 66 patients with acute posterior circulation stroke underwent MT. Data collected and analyzed included demographics, comorbidity, National Institutes of Health Stroke Scale (NIHSS), procedure time, site of occlusion, presence of posterior communicating artery (PCoA), endovascular technique, and modified Rankin Scale (mRS). Good clinical outcome was defined by mRS at 2 or less at 90 days after MT. Statistical Analysis  Variables with normal distribution were reported with mean ± standard deviation, meanwhile those with nonnormal distribution were demonstrated with median and range. Fisher's exact test for categorical variables or Mann–Whitney U test for continuous variables was performed. Multivariate logistic regression analysis with binary logistic regression method was used analyze the association between the prognosis factor and good outcome. Statistical significance was defined when p -value less than 0.05. Results  The mean age of patients was 65.2 years with male predominance. The median NIHSS was 18.5. Successful recanalization (modified thrombolysis in cerebral infarction 2b-3) was achieved in 61/66 cases (92.42%) and postprocedure symptomatic intracerebral hemorrhage occurred in 5/66 cases (7.60%). Successful recanalization with good clinical outcome was obtained from 30 of 61 cases (49.18%); it was also associated with distal basilar artery occlusion ( p  = 0.035) and PCoA patency presence ( p  = 0.024). Our study showed the correlation between good treatment outcomes with initial NIHSS less than 20, intravenous recombinant tissue-type plasminogen activator, pre-MT magnetic resonance imaging Q5 brain, and contact aspiration MT technique. Conclusion  MT is beneficial to patients with posterior circulation stroke. A good clinical outcome was significantly associated with distal basilar artery occlusion and PCoA patency presence within a group of successful recanalization.

[1]  Correction to: Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. , 2019, Stroke.

[2]  W. Powers,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. , 2019, Stroke.

[3]  G. Duckwiler,et al.  Posterior Circulation Thrombectomy - pcASPECT Score Applied to Pre-intervention MRI Can Accurately Predict Functional Outcome. , 2019, World neurosurgery.

[4]  M. Mazighi,et al.  Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever). , 2018, Journal of neurosurgery.

[5]  M. Hellström,et al.  Endovascular treatment of acute ischemic stroke in the posterior circulation , 2018, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[6]  J. Biller,et al.  Neuroimaging Predictors of Clinical Outcome in Acute Basilar Artery Occlusion , 2017, Front. Neurol..

[7]  B. Baxter,et al.  Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes , 2016, Stroke.

[8]  A. Padovani,et al.  Endovascular mechanical thrombectomy in basilar artery occlusion: variables affecting recanalization and outcome , 2016, Journal of Neurology.

[9]  A. Alexandrov,et al.  Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion , 2015, Journal of NeuroInterventional Surgery.

[10]  T. Neumann-Haefelin,et al.  Mechanical recanalization in basilar artery occlusion: The ENDOSTROKE study , 2015, Annals of neurology.

[11]  M. Kaste,et al.  Thrombolysis of basilar artery occlusion: Impact of baseline ischemia and time , 2013, Annals of neurology.

[12]  Gerhard Schroth,et al.  Basilar artery occlusion , 2011, The Lancet Neurology.

[13]  S. Uchiyama,et al.  Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome , 2010, Journal of Neurology.

[14]  D. Tanné,et al.  Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study , 2009, The Lancet Neurology.

[15]  M. Diringer,et al.  Relationship between clot location and outcome after basilar artery thrombolysis. , 1997, AJNR. American journal of neuroradiology.

[16]  D. Liebeskind,et al.  Factors Associated with 90-Day Outcomes of Patients with Acute Posterior Circulation Stroke Treated By Mechanical Thrombectomy. , 2018, World neurosurgery.