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J Neurol Surg B Skull Base
DOI: 10.1055/a-2065-9562
Original Article

A Study on the Efficacy of Thrombectomy in Patients with Atherosclerotic and Cardioembolic Basilar Artery Occlusion

Fulei Chen   *
1   Department of Neurosurgery, First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, China
,
Linzhi Dai   *
2   Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
,
Jiangtao Dong
2   Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
,
Licang Zhu
2   Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
,
Yang Li
2   Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
,
Lei Zhang
2   Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
,
Dong Zhao
2   Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
› Author Affiliations Funding This research received funding from National Natural Science Foundation of China, No. 81960222; The Young and Middle-Aged Leading Talents in Scientific and Technological Innovation of XPCC, No. 2020CB011.
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Abstract

Background Studies on basilar artery occlusion are relatively few compared with those of anterior circulation stroke. The aim of the present study was to compare the efficacy of endovascular therapy (EVT) in patients with basilar artery occlusion classified as large artery atherosclerosis (LAA) and cardioembolism (CE), and to analyze the independent risk factors affecting the prognosis of EVT.

Methods A total of 123 people were assigned to the LAA and CE groups (97 to the LAA and 26 to the CE). The primary outcome was a modified Rankin Scale (mRS) score of 2 or lower at 90 days. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial hemorrhage and reinfarction. Multiple logistic regression was used to screen out independent risk factors for EVT prognosis of the LAA and CE groups.

Results In the analysis, the patients with LAA stroke had better collateral circulation (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology [SIR] score of 2–4; 61.9 vs. 19.2%, p = 0.000), and higher angioplasty rate (32.0 vs. 3.8%, p = 0.002). The proportions of patients with a 90-day mRS score of 0 to 2 and 90-day mortality were not found to be statistically significant between the two groups. Multivariate logistic regression analysis indicated that age, SIR, white blood cell, blood glucose, and modified thrombolysis in cerebral infarction were independent risk factors for the poor prognosis of EVT in the LAA group.

Conclusions Although there were differences in clinical characteristics and imaging features between LAA and CE, there was no evidence of a significant difference in prognosis after EVT. In addition, the National Institutes of Health Stroke Scale score was not among the independent risk factors affecting the prognosis of the LAA group.

Keywords

basilar artery occlusion - intravascular therapy - large artery atherosclerosis - cardioembolism

* Both the authors contributed equally to this article.




Publication History

Received: 01 October 2022

Accepted: 27 March 2023

Accepted Manuscript online:
30 March 2023

Article published online:
01 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Feigin VL, Forouzanfar MH, Krishnamurthi R. et al; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383 (9913): 245-254
    CrossrefPubMedGoogle Scholar
  • 2 Wang W, Jiang B, Sun H. et al; NESS-China Investigators. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation 2017; 135 (08) 759-771
    CrossrefPubMedGoogle Scholar
  • 3 Liu X, Xu G, Liu Y. et al; BEST Trial Investigators. Acute basilar artery occlusion: Endovascular Interventions versus Standard Medical Treatment (BEST) Trial-Design and protocol for a randomized, controlled, multicenter study. Int J Stroke 2017; 12 (07) 779-785
    CrossrefPubMedGoogle Scholar
  • 4 Lee JS, Hong JM, Lee KS. et al. Endovascular therapy of cerebral arterial occlusions: intracranial atherosclerosis versus embolism. J Stroke Cerebrovasc Dis 2015; 24 (09) 2074-2080
    CrossrefPubMedGoogle Scholar
  • 5 Chinese Stroke Association. Chinese guidelines for endovascular treatment of acute ischemic stroke 2018. Chinese Journal of Stroke 2018; 013: 706-729
    PubMedGoogle Scholar
  • 6 Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000; 355 (9216): 1670-1674
    CrossrefPubMedGoogle Scholar
  • 7 Tian C, Cao X, Wang J. Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion: choice of therapeutic strategy according to underlying aetiological mechanism?. Stroke Vasc Neurol 2017; 2 (04) 244-250
    CrossrefPubMedGoogle Scholar
  • 8 Ma YH, Leng XY, Dong Y. et al. Risk factors for intracranial atherosclerosis: a systematic review and meta-analysis. Atherosclerosis 2019; 281: 71-77
    CrossrefPubMedGoogle Scholar
  • 9 Sato Y, Ishibashi-Ueda H, Iwakiri T. et al. Thrombus components in cardioembolic and atherothrombotic strokes. Thromb Res 2012; 130 (02) 278-280
    CrossrefPubMedGoogle Scholar
  • 10 Sun C, Li X, Zhao Z. et al. Safety and efficacy of tirofiban combined with mechanical thrombectomy depend on ischemic stroke etiology. Front Neurol 2019; 10: 1100
    CrossrefPubMedGoogle Scholar
  • 11 Bang OY. Intracranial atherosclerosis: current understanding and perspectives. J Stroke 2014; 16 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 12 Gounis MJ, Chapot R. Histological composition and the origin of the thrombus: a new diagnostic assay for secondary stroke prevention?. Stroke 2017; 48 (08) 2040-2041
    CrossrefPubMedGoogle Scholar
  • 13 Kim YW, Hong JM, Park DG. et al. Effect of intracranial atherosclerotic disease on endovascular treatment for patients with acute vertebrobasilar occlusion. AJNR Am J Neuroradiol 2016; 37 (11) 2072-2078
    CrossrefPubMedGoogle Scholar
  • 14 Zhou TF, Zhu LF, Li TX. et al. Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke. J Interv Med 2019; 1 (02) 77-81
    PubMedGoogle Scholar
  • 15 Jafari M, Nguyen TN, Ortega-Gutierrez S. et al. Current advances in endovascular treatment of intracranial atherosclerotic disease and future prospective. J Stroke Cerebrovasc Dis 2021; 30 (03) 105556
    CrossrefPubMedGoogle Scholar
  • 16 Yoon W, Kim SK, Park MS, Kim BC, Kang HK. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery 2015; 76 (06) 680-686 , discussion 686
    CrossrefPubMedGoogle Scholar
  • 17 Alonso de Leciñana M, Kawiorski MM, Ximénez-Carrillo Á. et al; Madrid Stroke Network. Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions. J Neurointerv Surg 2017; 9 (12) 1173-1178
    CrossrefPubMedGoogle Scholar
  • 18 Shi Z-S, Liebeskind DS, Xiang B. et al; Multi MERCI, TREVO, and TREVO 2 Investigators. Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes. Stroke 2014; 45 (07) 1977-1984
    CrossrefPubMedGoogle Scholar
  • 19 Linfante I, Starosciak AK, Walker GR. et al. Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry. J Neurointerv Surg 2016; 8 (03) 224-229
    CrossrefPubMedGoogle Scholar
  • 20 Zhai FF, Yan S, Li ML. et al. Intracranial arterial dolichoectasia and stenosis: risk factors and relation to cerebral small vessel disease. Stroke 2018; 49 (05) 1135-1140
    CrossrefPubMedGoogle Scholar
  • 21 Chuang Y-M, Chan L, Lai Y-J. et al. Configuration of the circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis. J Crit Care 2013; 28 (02) 166-172
    CrossrefPubMedGoogle Scholar
  • 22 Yoo AJ, Simonsen CZ, Prabhakaran S. et al; Cerebral Angiographic Revascularization Grading Collaborators. Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 2013; 44 (09) 2509-2512
    CrossrefPubMedGoogle Scholar
  • 23 Huber T, Kleine JF, Kaesmacher J. et al. Blood leukocytes as prognostic parameter in stroke thrombectomy. Cerebrovasc Dis 2016; 42 1–2 32-40
    CrossrefPubMedGoogle Scholar
  • 24 Behme D, Gondecki L, Fiethen S, Kowoll A, Mpotsaris A, Weber W. Complications of mechanical thrombectomy for acute ischemic stroke-a retrospective single-center study of 176 consecutive cases. Neuroradiology 2014; 56 (06) 467-476
    CrossrefPubMedGoogle Scholar
  • 25 O'Farrell FM, Mastitskaya S, Hammond-Haley M, Freitas F, Wah WR, Attwell D. Capillary pericytes mediate coronary no-reflow after myocardial ischaemia. eLife 2017; 6: e29280
    CrossrefPubMedGoogle Scholar
  • 26 Schneck MJ. Current stroke scales may be partly responsible for worse outcomes in posterior circulation stroke. Stroke 2018; 49 (11) 2565-2566
    CrossrefPubMedGoogle Scholar