Mechanical thrombectomy in basilar artery occlusions: impact of first-line strategy as a function of the occlusion level.

IF 4.5 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2025-03-17 DOI:10.1136/jnis-2024-021491

Louis Tournier, Jonathan Cortese, Arturo Consoli, Laurent Spelle, Gaultier Marnat, Mariana Sarov, Francois Zhu, Sebastien Soize, Julien Burel, Géraud Forestier, Simon Escalard, Raoul Pop, Baptiste Bonnet, Quentin Alias, Julien Ognard, Olivier Naggara, Maeva Kyheng, Bertrand Lapergue, Jildaz Caroff

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引用次数: 0

Abstract

Background: Retrospective studies suggest the superiority of first-line contact aspiration (CA) thrombectomy over stent-retriever (SR) in basilar artery occlusions (BAO). We aimed to investigate the impact of first-line mechanical thrombectomy per the occlusion level, considering differences in stroke etiology prevalence between proximal and distal BAO.

Methods: A retrospective, multicentric analysis of the Endovascular Treatment in Ischemic Stroke Registry (ETIS) included consecutive BAO patients treated from January 2016 to May 2022. Patients were categorized into SR (±aspiration) and CA alone groups. Occlusion levels were determined through digital subtraction angiography. Favorable clinical outcome was defined as 90-day modified Rankin Scale (mRS) 0-3.

Results: A total of 380 patients were analyzed (251 CA alone, 129 SR±aspiration). Globally, first-line SR showed lower recanalization rates (89.1% vs 94.8%, OR=0.29, 95% CI 0.16 to 0.53; p<0.001) and worse clinical outcomes (mRS 0-3: 46.0% vs 52.2%, OR=0.62, 95% CI 0.44 to 0.87; p=0.006) compared with CA. In proximal occlusions, SR was significantly associated with poorer clinical outcomes (mRS 0-3: 20.9% vs 37.1%; OR=0.40, 95% CI 0.19 to 0.83; p=0.014) despite similar recanalization rates. Conversely, in distal occlusions there was no difference in clinical outcomes although recanalization rates were higher with CA (modified Thrombolysis in Cerebral Infarction score (mTICI 2b/3): 97.7% vs 91.7%; OR=0.17, 95% CI 0.05 to 0.66; p=0.01).

Conclusions: In our BAO population, CA demonstrated better angiographic outcomes in middle and distal occlusions and better clinical outcomes in proximal occlusions. This translated into better angiographic and clinical results in the global study population. Clinical results were particularly influenced by the negative impact of SR on 90-day mRS, independently of recanalization rates in proximal BAO.

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基底动脉闭塞时的机械取栓术：一线策略对闭塞程度的影响。

背景：回顾性研究表明，在基底动脉闭塞症（BAO）中，一线接触抽吸术（CA）血栓切除术优于支架截流术（SR）。考虑到近端和远端 BAO 中风病因发生率的差异，我们旨在研究一线机械性血栓切除术对闭塞程度的影响：缺血性卒中血管内治疗注册中心（ETIS）的一项多中心回顾性分析纳入了2016年1月至2022年5月期间接受治疗的连续BAO患者。患者被分为SR（±吸入）组和单纯CA组。闭塞程度通过数字减影血管造影确定。90天改良Rankin量表（mRS）0-3为良好临床结果：结果：共分析了380例患者（251例单纯CA组，129例SR±吸入组）。总体而言，一线 SR 的再通率较低（89.1% vs 94.8%，OR=0.29，95% CI 0.16 至 0.53；p结论：在我们的 BAO 患者中，CA 对中远端闭塞显示出更好的血管造影结果，对近端闭塞显示出更好的临床结果。这在全球研究人群中转化为更好的血管造影和临床结果。临床结果尤其受到 SR 对 90 天 mRS 负面影响的影响，这与近端 BAO 的再通率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.