Endovascular thrombectomy for basilar artery occlusion stroke: Analysis of the German Stroke Registry-Endovascular Treatment.
acute stroke
basilar artery occlusion
endovascular therapy
functional outcome
intravenous thrombolysis
ischemic stroke
mechanical thrombectomy
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
05
01
2023
received:
06
12
2022
accepted:
09
01
2023
medline:
6
4
2023
pubmed:
25
1
2023
entrez:
24
1
2023
Statut:
ppublish
Résumé
Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice. Patients enrolled between June 2015 and December 2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3), substantial neurological improvement (≥8-point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge ≤1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0-2). Out of 6635 GSR-ET patients, 640 (9.6%) patients (age 72.2 ± 13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3-month follow-up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76-5.23) and successful reperfusion (OR 4.92, 95% CI 1.15-21.11), while the effect of time between symptom onset and reperfusion seemed to be small. Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact.
Sections du résumé
BACKGROUND AND PURPOSE
Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice.
METHODS
Patients enrolled between June 2015 and December 2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3), substantial neurological improvement (≥8-point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge ≤1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0-2).
RESULTS
Out of 6635 GSR-ET patients, 640 (9.6%) patients (age 72.2 ± 13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3-month follow-up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76-5.23) and successful reperfusion (OR 4.92, 95% CI 1.15-21.11), while the effect of time between symptom onset and reperfusion seemed to be small.
CONCLUSIONS
Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1293-1302Investigateurs
Tobias Boeckh-Behrens
(T)
Silke Wunderlich
(S)
Alexander Ludolph
(A)
Karl-Heinz Henn
(KH)
Arno Reich
(A)
Omid Nikoubashman
(O)
Martin Wiesmann
(M)
Ulrike Ernemann
(U)
Sven Poli
(S)
Christian H Nolte
(CH)
Eberhard Siebert
(E)
Sarah Zweynert
(S)
Georg Bohner
(G)
Laszlo Solymosi
(L)
Gabor Petzold
(G)
Waltraud Pfeilschifter
(W)
Fee Keil
(F)
Joachim Röther
(J)
Bernd Eckert
(B)
Jörg Berrouschot
(J)
Albrecht Bormann
(A)
Anna Alegiani
(A)
Jens Fiehler
(J)
Christian Gerloff
(C)
Götz Thomalla
(G)
Sven Thonke
(S)
Christopher Bangard
(C)
Christoffer Kraemer
(C)
Martin Dichgans
(M)
Marios Psychogios
(M)
Jan Liman
(J)
Martina Petersen
(M)
Florian Stögbauer
(F)
Peter Kraft
(P)
Mirko Pham
(M)
Michael Braun
(M)
Gerhard F Hamann
(GF)
Christian Roth
(C)
Klaus Gröschel
(K)
Timo Uphaus
(T)
Volker Limmroth
(V)
Informations de copyright
© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
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