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Erschienen in: Neuroradiology 6/2020

13.02.2020 | Interventional Neuroradiology

Thrombectomy in acute vertebrobasilar occlusion: a single-centre experience

verfasst von: Dong Hyuk Lee, Seung Hwan Kim, Hyungon Lee, Su Bin Kim, Dongah Lee, Young Jin Heo, Jin Wook Baek, Hye Jin Kim, Jung-Soo Kim, Jung Hyun Park, Hae Woong Jeong, Hae Yu Kim, Sung-Chul Jin

Erschienen in: Neuroradiology | Ausgabe 6/2020

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Abstract

Purpose

Acute vertebrobasilar occlusion (VBO) has a grave clinical course; however, thrombectomy in VBO patients has rarely been reported. We retrospectively evaluated the clinical and radiological outcomes of thrombectomy in VBO patients.

Methods

From March 2010 to December 2017, 38 patients with 40 acute VBOs underwent thrombectomy at our hospital. Thrombectomy was performed using catheter aspiration (n = 11, 26.8%) or a stent retriever (n = 29, 70.7%).

Results

Good clinical outcomes (3-month modified Rankin scale (mRS) of 2 or lower) were achieved in 9 cases (22.5%), and successful recanalization (thrombolysis in cerebral infarction (TICI) grade of 2b or 3) was achieved in 35 cases (87.5%). Good clinical outcomes were significantly related to aetiologies other than atherosclerosis (p = 0.020) and lower National Institutes of Health Stroke Scale (NIHSS) scores on admission (p = 0.025). The clinical and radiological outcomes did not differ significantly between catheter aspiration and stent retriever thrombectomy (p = 1.000 and p = 0.603, respectively); however, stent retriever thrombectomy had a shorter procedure time than catheter aspiration (59.7 ± 31.2 vs. 84.5 ± 35.1 min, p = 0.037).

Conclusion

In our series, good clinical outcomes were associated with a lower NIHSS score on admission and stroke aetiologies other than atherosclerosis. The two thrombectomy modalities showed similar clinical and radiological outcomes. However, stent retrievers seemed to allow more rapid recanalization than catheter aspiration in VBO.
Literatur
1.
Zurück zum Zitat Fahed R, Di Maria F, Rosso C et al (2017) A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study. J Neurosurg 126:1578–1584CrossRef Fahed R, Di Maria F, Rosso C et al (2017) A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study. J Neurosurg 126:1578–1584CrossRef
2.
Zurück zum Zitat Yang H, Ma N, Zhang S, Huo X, Gao F, Sun X, Mo D, Miao Z (2018) Endovascular revascularisation of acute tandem vertebrobasilar artery occlusion: seven case series with literature reviews. Stroke Vasc Neurol 3:17–21CrossRef Yang H, Ma N, Zhang S, Huo X, Gao F, Sun X, Mo D, Miao Z (2018) Endovascular revascularisation of acute tandem vertebrobasilar artery occlusion: seven case series with literature reviews. Stroke Vasc Neurol 3:17–21CrossRef
3.
Zurück zum Zitat Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Maeda K, Ikai Y, Gi H (2017) Mechanical thrombectomy for acute basilar artery occlusion in early therapeutic time window. Cerebrovasc Dis 44:217–224CrossRef Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Maeda K, Ikai Y, Gi H (2017) Mechanical thrombectomy for acute basilar artery occlusion in early therapeutic time window. Cerebrovasc Dis 44:217–224CrossRef
4.
Zurück zum Zitat Mak CH-K, Ho JW-K, Chan K-Y et al (2016) Intra-arterial revascularization therapy for basilar artery occlusion—a systematic review and analysis. Neurosurg Rev 39:575–580CrossRef Mak CH-K, Ho JW-K, Chan K-Y et al (2016) Intra-arterial revascularization therapy for basilar artery occlusion—a systematic review and analysis. Neurosurg Rev 39:575–580CrossRef
5.
Zurück zum Zitat Long J, Qin H, Zhang H (2017) Evaluation of recanalisation treatment on posterior circulation ischemic stroke by Solitaire device—a multicenter retrospective study. Neurol Neurochir Pol 51:208–213CrossRef Long J, Qin H, Zhang H (2017) Evaluation of recanalisation treatment on posterior circulation ischemic stroke by Solitaire device—a multicenter retrospective study. Neurol Neurochir Pol 51:208–213CrossRef
6.
Zurück zum Zitat Luo G, Mo D, Tong X, Liebeskind DS, Song L, Ma N, Gao F, Sun X, Zhang X, Wang B, Jia B, Fernandez-Escobar A, Miao Z (2018) Factors associated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy. World Neurosurg 109:e318–e328CrossRef Luo G, Mo D, Tong X, Liebeskind DS, Song L, Ma N, Gao F, Sun X, Zhang X, Wang B, Jia B, Fernandez-Escobar A, Miao Z (2018) Factors associated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy. World Neurosurg 109:e318–e328CrossRef
7.
Zurück zum Zitat van Houwelingen RC, Luijckx G-J, Mazuri A et al (2016) Safety and outcome of intra-arterial treatment for basilar artery occlusion. JAMA Neurol 73:1225CrossRef van Houwelingen RC, Luijckx G-J, Mazuri A et al (2016) Safety and outcome of intra-arterial treatment for basilar artery occlusion. JAMA Neurol 73:1225CrossRef
8.
Zurück zum Zitat Qureshi AI, Caplan LR (2014) Intracranial atherosclerosis. Lancet 383:984–998CrossRef Qureshi AI, Caplan LR (2014) Intracranial atherosclerosis. Lancet 383:984–998CrossRef
9.
Zurück zum Zitat Banerjee C, Chimowitz MI (2017) Stroke caused by atherosclerosis of the major intracranial arteries. Circ Res 120:502–513CrossRef Banerjee C, Chimowitz MI (2017) Stroke caused by atherosclerosis of the major intracranial arteries. Circ Res 120:502–513CrossRef
10.
Zurück zum Zitat Kim SJ, Ryoo S, Bang OY, Chung CS, Lee KH, Kim GM (2010) Perfusion-weighted MRI as a predictor of clinical outcomes following medullary infarctions. Cerebrovasc Dis 29:382–388CrossRef Kim SJ, Ryoo S, Bang OY, Chung CS, Lee KH, Kim GM (2010) Perfusion-weighted MRI as a predictor of clinical outcomes following medullary infarctions. Cerebrovasc Dis 29:382–388CrossRef
11.
Zurück zum Zitat Kistler JP, Furie KL (2000) Carotid endarterectomy revisited. N Engl J Med 342:1743–1745CrossRef Kistler JP, Furie KL (2000) Carotid endarterectomy revisited. N Engl J Med 342:1743–1745CrossRef
12.
Zurück zum Zitat Labropoulos N, Nandivada P, Bekelis K (2011) Stroke of the posterior cerebral circulation. Int Angiol 30:105–114PubMed Labropoulos N, Nandivada P, Bekelis K (2011) Stroke of the posterior cerebral circulation. Int Angiol 30:105–114PubMed
13.
Zurück zum Zitat Kang D-H, Kim Y-W, Hwang Y-H et al (2014) Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis 37:350–355CrossRef Kang D-H, Kim Y-W, Hwang Y-H et al (2014) Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis 37:350–355CrossRef
14.
Zurück zum Zitat Mordasini P, Brekenfeld C, Byrne JV et al (2013) Technical feasibility and application of mechanical thrombectomy with the Solitaire FR revascularization device in acute basilar artery occlusion. Am J Neuroradiol 34:159–163CrossRef Mordasini P, Brekenfeld C, Byrne JV et al (2013) Technical feasibility and application of mechanical thrombectomy with the Solitaire FR revascularization device in acute basilar artery occlusion. Am J Neuroradiol 34:159–163CrossRef
15.
Zurück zum Zitat Tian C, Cao X, Wang J (2017) 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 2:244–250CrossRef Tian C, Cao X, Wang J (2017) 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 2:244–250CrossRef
16.
Zurück zum Zitat Fromm A, Waje-Andreassen U, Thomassen L et al (2011) Comparison between ischemic stroke patients <50 years and ≥50 years admitted to a single centre: the Bergen stroke study. Stroke Res Treat 20:183256 Fromm A, Waje-Andreassen U, Thomassen L et al (2011) Comparison between ischemic stroke patients <50 years and ≥50 years admitted to a single centre: the Bergen stroke study. Stroke Res Treat 20:183256
17.
Zurück zum Zitat Niu J, Ding Y, Zhai T et al (2019) The efficacy and safety of tirofiban for patients with acute ischemic stroke: a protocol for systematic review and a meta-analysis. Medicine (Baltimore) 98:e14673CrossRef Niu J, Ding Y, Zhai T et al (2019) The efficacy and safety of tirofiban for patients with acute ischemic stroke: a protocol for systematic review and a meta-analysis. Medicine (Baltimore) 98:e14673CrossRef
18.
Zurück zum Zitat Yu T, Lin Y, Jin A, Zhang P, Zhou X, Fang M, Liu X (2018) Safety and efficiency of low dose intra-arterial tirofiban in mechanical thrombectomy during acute ischemic stroke. Curr Neurovasc Res 15:145–150CrossRef Yu T, Lin Y, Jin A, Zhang P, Zhou X, Fang M, Liu X (2018) Safety and efficiency of low dose intra-arterial tirofiban in mechanical thrombectomy during acute ischemic stroke. Curr Neurovasc Res 15:145–150CrossRef
19.
Zurück zum Zitat Xianxian Z, Chengsong Y, Qiang M et al (2017) The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion. Int J Biol Sci 13:57–64CrossRef Xianxian Z, Chengsong Y, Qiang M et al (2017) The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion. Int J Biol Sci 13:57–64CrossRef
20.
Zurück zum Zitat Young FB, Weir CJ, Lees KR (2005) Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke 36:2187–2192CrossRef Young FB, Weir CJ, Lees KR (2005) Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke 36:2187–2192CrossRef
21.
Zurück zum Zitat Gory B, Mazighi M, Labreuche J, Blanc R, Piotin M, Turjman F, Lapergue B, ETIS (Endovascular Treatment in Ischemic Stroke) Investigators (2018) Predictors for mortality after mechanical thrombectomy of acute basilar artery occlusion. Cerebrovasc Dis 45:61–67CrossRef Gory B, Mazighi M, Labreuche J, Blanc R, Piotin M, Turjman F, Lapergue B, ETIS (Endovascular Treatment in Ischemic Stroke) Investigators (2018) Predictors for mortality after mechanical thrombectomy of acute basilar artery occlusion. Cerebrovasc Dis 45:61–67CrossRef
22.
Zurück zum Zitat Linfante I, Llinas RH, Schlaug G et al (2001) Diffusion-weighted imaging and National Institutes of Health Stroke Scale in the acute phase of posterior-circulation stroke. Arch Neurol 58:621–628CrossRef Linfante I, Llinas RH, Schlaug G et al (2001) Diffusion-weighted imaging and National Institutes of Health Stroke Scale in the acute phase of posterior-circulation stroke. Arch Neurol 58:621–628CrossRef
23.
Zurück zum Zitat Tsao JW, Hemphill JC, Johnston SC et al (2005) Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke. Arch Neurol 62:1126CrossRef Tsao JW, Hemphill JC, Johnston SC et al (2005) Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke. Arch Neurol 62:1126CrossRef
24.
Zurück zum Zitat Neuberger U, Kickingereder P, Schönenberger S, Schieber S, Ringleb PA, Bendszus M, Pfaff J, Möhlenbruch MA (2019) Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke. Neuroradiology 61:461–469CrossRef Neuberger U, Kickingereder P, Schönenberger S, Schieber S, Ringleb PA, Bendszus M, Pfaff J, Möhlenbruch MA (2019) Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke. Neuroradiology 61:461–469CrossRef
25.
Zurück zum Zitat Kwon J-H, Shin SH, Weon YC et al (2011) Intra-arterial adjuvant tirofiban after unsuccessful intra-arterial thrombolysis of acute ischemic stroke: preliminary experience in 16 patients. Neuroradiology 53:779–785CrossRef Kwon J-H, Shin SH, Weon YC et al (2011) Intra-arterial adjuvant tirofiban after unsuccessful intra-arterial thrombolysis of acute ischemic stroke: preliminary experience in 16 patients. Neuroradiology 53:779–785CrossRef
26.
Zurück zum Zitat Son S, Choi DS, Oh MK, Hong J, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH (2016) Comparison of Solitaire thrombectomy and Penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg 8:13–18CrossRef Son S, Choi DS, Oh MK, Hong J, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH (2016) Comparison of Solitaire thrombectomy and Penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg 8:13–18CrossRef
27.
Zurück zum Zitat Li W, Lin L, Zhang M et al (2016) Safety and preliminary efficacy of early tirofiban treatment after alteplase in acute ischemic stroke patients. Stroke 47:2649–2651CrossRef Li W, Lin L, Zhang M et al (2016) Safety and preliminary efficacy of early tirofiban treatment after alteplase in acute ischemic stroke patients. Stroke 47:2649–2651CrossRef
28.
Zurück zum Zitat Kim BJ, Kim JS (2014) Ischemic stroke subtype classification: an asian viewpoint. J Stroke 16:8–17CrossRef Kim BJ, Kim JS (2014) Ischemic stroke subtype classification: an asian viewpoint. J Stroke 16:8–17CrossRef
29.
Zurück zum Zitat Kang DH, Yoon W, Baek BH et al (2019) Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration. J Neurosurg 29:1–7 Kang DH, Yoon W, Baek BH et al (2019) Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration. J Neurosurg 29:1–7
Metadaten
Titel
Thrombectomy in acute vertebrobasilar occlusion: a single-centre experience
verfasst von
Dong Hyuk Lee
Seung Hwan Kim
Hyungon Lee
Su Bin Kim
Dongah Lee
Young Jin Heo
Jin Wook Baek
Hye Jin Kim
Jung-Soo Kim
Jung Hyun Park
Hae Woong Jeong
Hae Yu Kim
Sung-Chul Jin
Publikationsdatum
13.02.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Neuroradiology / Ausgabe 6/2020
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-020-02376-1

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