• World Neurosurg · Feb 2020

    Comparative Study Observational Study

    Mechanical thrombectomy for basilar artery occlusion compared with anterior circulation stroke: Mechanical thrombectomy for basilar artery occlusion.

    • Junji Uno, Katsuharu Kameda, Ryosuke Otsuji, Nice Ren, Shintaro Nagaoka, Kazushi Maeda, Yoshiaki Ikai, and Hidefuku Gi.
    • Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan. Electronic address: babahpns@silver.ocn.ne.jp.
    • World Neurosurg. 2020 Feb 1; 134: e469-e475.

    ObjectiveTo investigate the clinical effectiveness of mechanical thrombectomy (MT) for basilar artery occlusion (BAO) and to ascertain whether outcomes for patients with BAO were comparable to those with anterior circulation large vessel occlusion (ACS).MethodsA total of 345 patients who underwent MT between 2011 and 2018 were grouped by occlusion site (295 patients with ACS and 50 patients with BAO). Patients' baseline characteristics, procedural times, complications, symptomatic intracranial hemorrhage, modified Rankin Scale score, and mortality at 90 days were analyzed.ResultsMale preponderance (66.0% vs. 48.8%; P = 0.0316), younger age (72.5 years [interquartile range (IQR), 64.75-78.5 years] vs. 77 years [IQR 69-84 years]; P = 0.0297), higher National Institutes of Health Stroke Scale score (24.5 [IQR, 13-32] vs. 18 [IQR 13-22]; P = 0.0015) and higher reperfusion rate (100% vs. 84.7%; P = 0.0010) were observed in patients with BAO. We found no significant difference in favorable outcomes (modified Rankin Scale score ≤2) between patients with BAO and patients with ACS (64.3% vs. 49.3%; P = 0.0914). In multivariate analysis, Alberta Stroke Program Early Computed Tomography Score (odds ratio [OR], 1.282; 95% confidence interval [CI], 1.090-1.524; P = 0.0024), time from onset to reperfusion (OTR) (OR, 0.9950; 95% CI, 0.992-0.998; P = 0.0008), successful reperfusion (OR, 6.953; 95% CI, 1.576-48.729; P = 0.0092), and hemorrhagic complication (OR, 0.352; 95% CI, 0.151-0.797; P = 0.0122) were associated with a favorable outcome at 90 days in patients with ACS. In patients with BAO, only OTR (OR, 0.9879; 95% CI, 0.974-0.999; P = 0.0314) was associated with a favorable outcome at 90 days.ConclusionsMT may be considered the standard care for patients with BAO. OTR was the only common significant predictor for favorable outcomes in both patient cohorts.Copyright © 2019 Elsevier Inc. All rights reserved.

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