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.

Keywords

posterior circulation stroke - mechanical thrombectomy - acute stroke

• References

• 1 Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol 2011; 10 (11) 1002-1014
• 2 Strbian D, Sairanen T, Silvennoinen H, Salonen O, Kaste M, Lindsberg PJ. Thrombolysis of basilar artery occlusion: impact of baseline ischemia and time. Ann Neurol 2013; 73 (06) 688-694
• 3 Schonewille WJ, Wijman CA, Michel P. et al; BASICS study group. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 2009; 8 (08) 724-730
• 4 Singer OC, Berkefeld J, Nolte CH. et al; ENDOSTROKE Study Group. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 2015; 77 (03) 415-424
• 5 Powers WJ, Rabinstein AA, Ackerson T. 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. Stroke 2019; 50 (12) e344-e418
• 6 Luo G, Mo D, Tong X. et al. Factors associated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy. World Neurosurg 2018; 109: e318-e328
• 7 Mokin M, Sonig A, Sivakanthan S. et al. Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke 2016; 47 (03) 782-788
• 8 Khatibi K, Nour M, Tateshima S. et al. Posterior circulation thrombectomy-pc-ASPECT score applied to preintervention magnetic resonance imaging can accurately predict functional outcome. World Neurosurg 2019; 129: e566-e571
• 9 Tei H, Uchiyama S, Usui T, Ohara K. Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome. J Neurol 2010; 257 (05) 767-773
• 10 Garg R, Biller J. Neuroimaging predictors of clinical outcome in acute basilar artery occlusion. Front Neurol 2017; 8: 293
• 11 Gilberti N, Gamba M, Premi E. et al. Endovascular mechanical thrombectomy in basilar artery occlusion: variables affecting recanalization and outcome. J Neurol 2016; 263 (04) 707-713
• 12 Rentzos A, Karlsson J-E, Lundqvist C, Rosengren L, Hellström M, Wikholm G. Endovascular treatment of acute ischemic stroke in the posterior circulation. Interv Neuroradiol 2018; 24 (04) 405-411
• 13 Goyal N, Tsivgoulis G, Nickele C. et al. Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion. J Neurointerv Surg 2016; 8 (08) 783-786
• 14 Cross III DT, Moran CJ, Akins PT, Angtuaco EE, Diringer MN. Relationship between clot location and outcome after basilar artery thrombolysis. AJNR Am J Neuroradiol 1997; 18 (07) 1221-1228
• 15 Gory B, Mazighi M, Blanc R. 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). J Neurosurg 2018; 129 (06) 1482-1491