Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion.

Humans Basilar Artery / diagnostic imaging Stroke / diagnostic imaging Prospective Studies Treatment Outcome Thrombectomy / methods Cerebral Infarction / etiology Arterial Occlusive Diseases / diagnostic imaging Ischemic Stroke / etiology Reperfusion Retrospective Studies Endovascular Procedures / methods

Stroke Thrombectomy

Journal

Journal of neurointerventional surgery

ISSN: 1759-8486

Titre abrégé: J Neurointerv Surg

Pays: England

ID NLM: 101517079

Informations de publication

Date de publication:
May 2023

Historique:

received: 24 01 2022

accepted: 05 04 2022

medline: 17 4 2023

pubmed: 23 4 2022

entrez: 22 4 2022

Statut: ppublish

Résumé

The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes. We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect. We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901). We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect.

RESULTS RESULTS

We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901).

CONCLUSIONS CONCLUSIONS

We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure.

Identifiants

DOI: 10.1136/neurintsurg-2022-018715 PMID: 35450929

pubmed: 35450929

pii: neurintsurg-2022-018715

doi: 10.1136/neurintsurg-2022-018715

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

422-427

Investigateurs

Michel Piotin (M)

Raphael Blanc (R)

Hocine Redjem (H)

Simon Escalard (S)

Jean-Philippe Dessilles (JP)

François Delvoye (F)

Stanislas Smajda (S)

Benjamin Maier (B)

Hebert Solène (H)

Mikael Mazighi (M)

Mikael Obadia (M)

Candice Sabben (C)

Pierre Seners (P)

Igor Raynouard (I)

Ovide Corabianu (O)

Thomas de Broucker (T)

Eric Manchon (E)

Guillaume Taylor (G)

Malek Ben Maacha (MB)

Laurie-Anne Thion (LA)

Augustin Lecler (A)

Julien Savatovsjy (J)

Adrien Wang (A)

Serge Evrard (S)

Maya Tchikviladze (M)

Nadia Ajili (N)

Bertrand Lapergue (B)

David WeisenburgerLile (D)

Lucas Gorza (L)

Géraldine Buard (G)

Oguzhan Coskun (O)

Arturo Consoli (A)

Federico Di Maria (FD)

Georges Rodesh (G)

Sergio Zimatore (S)

Morgan Leguen (M)

Julie Gratieux (J)

Fernando Pico (F)

Haja Rakotoharinandrasana (H)

Philippe Tassan (P)

Roxanna Poll (R)

Sylvie Marinier (S)

Gaultier Marnat (G)

Florent Gariel (F)

Xavier Barreau (X)

Jérôme Berge (J)

Patrice Menegon (P)

Igor Sibon (I)

Ludovic Lucas (L)

Stéphane Olindo (S)

Pauline Renou (P)

Sharmila Sagnier (S)

Mathilde Poli (M)

Sabrina Debruxelles (S)

François Rouanet (F)

Thomas Tourdias (T)

Jean-Sebastien Liegey (JS)

Pierre Briau (P)

Nicolas Pangon (N)

Romain Bourcier (R)

Lili Detraz (L)

Benjamin Daumas-Duport (B)

Pierre-Louis Alexandre (PL)

Monica Roy (M)

Cédric Lenoble (C)

Hubert Desal (H)

Benoît Guillon (B)

Solène de Gaalon (S)

Cécile Preterre (C)

Benjamin Gory (B)

Serge Bracard (S)

René Anxionnat (R)

Marc Braun (M)

Anne-Laure Derelle (AL)

Liang Liao (L)

François Zhu (F)

Emmanuelle Schmitt (E)

Sophie Planel (S)

Sébastien Richard (S)

Lisa Humbertjean (L)

Gioia Mione (G)

Jean-Christophe Lacour (JC)

Marian Douarinou (M)

Gérard Audibert (G)

Marcela Voicu (M)

Lionel Alb (L)

Marie Reitter (M)

Madalina Brezeanu (M)

Agnès Masson (A)

Adriana Tabarna (A)

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Pauline Bourst (P)

Valérie Georges (V)

Sarah Guy (S)

Fatiha Bechiri (F)

Francisco Macian-Montoro (F)

Suzanna Saleme (S)

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Alexandre Cosnard (A)

Vincent Costalat (V)

Caroline Arquizan (C)

Cyril Dargazanli (C)

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Carlos Riquelme (C)

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Isabelle Mourand (I)

Lucas Corti (L)

Federico Cagnazzo (F)

Adrien Ter Schiphorst (AT)

Francois Eugene (F)

Stéphane Vannier (S)

Jean-Christophe Ferre (JC)

Hélène Raoult (H)

Thomas Ronziere (T)

Maria Lassale (M)

Christophe Paya (C)

Jean-Yves Gauvrit (JY)

Clément Tracol (C)

Sophie Langnier-Lemercier (S)

Axelle Maurice (A)

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Mélanie Pinault (M)

Eimad Shotar (E)

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Stéphanie Lenck (S)

Kévin Premat (K)

Yves Samson Anne Léger (YSA)

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Flore Baronnet (F)

Sonia Alamowitch (S)

Laure Bottin (L)

Mathon Yger (M)

Vincent Degos (V)

Laurent Spelle (L)

Christian Denier (C)

Olivier Chassin (O)

Vanessa Chalumeau (V)

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Anne Christine Januel (AC)

Jean-Marc Olivot (JM)

Nicolas Raposo (N)

Fabrice Bonneville (F)

Jean François Albucher (JF)

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Jean Darcourt (J)

Guillaume Bellanger (G)

Philippe Tall (P)

Emmanuel Touze (E)

Charlotte Barbier (C)

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Marion Boulanger (M)

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Maxime Gauberti (M)

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Informations de copyright

Déclaration de conflit d'intérêts

Competing interests: None declared.