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

Authors :
de Havenon, Adam
Elhorany, Mahmoud
Boulouis, Gregoire
Naggara, Olivier
Darcourt, Jean
Clarençon, Frédéric
Richard, Sébastien
Marnat, Gaultier
Bourcier, Romain
Sibon, Igor
Arquizan, Caroline
Dargazanli, Cyril
Maïer, Benjamin
Seners, Pierre
Lapergue, Bertrand
Consoli, Arturo
Eugene, Francois
Vannier, Stephane
Caroff, Jildaz
Denier, Christian
Source :
Journal of NeuroInterventional Surgery; May2023, Vol. 15 Issue 5, p422-427, 131p
Publication Year :
2023

Abstract

Background 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. 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 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 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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17598478
Volume :
15
Issue :
5
Database :
Complementary Index
Journal :
Journal of NeuroInterventional Surgery
Publication Type :
Academic Journal
Accession number :
164040800
Full Text :
https://doi.org/10.1136/neurintsurg-2022-018715