Abstract 85: One-year Outcomes After Endovascular Treatment for Posterior Circulation Tandem Occlusions: A Multicenter Experience of 249 Patients

Abstract

Introduction: Endovascular thrombectomy (EVT) in posterior circulation tandem occlusions can be challenging and the current evidence is limited to retrospective case series with small sample sizes. Method: Consecutive patients from both PRESIST (ChiCTR2000033211) and BASILAR (ChiCTR1800014759) prospective registries between 2014 and 2022 were included with a total of 53 centers. Posterior circulation tandem occlusion was defined as stroke due to intracranial vertebral (V4), basilar, or posterior cerebral artery (PCA) occlusions, with tandem steno-occlusive lesion >70% of the extracranial vertebral artery and impaired distal flow or partial filling of the VA from collaterals. Outcomes included successful reperfusion defined as modified Thrombolysis in Cerebral Infarction (mTICI) of 2b-3, symptomatic intracerebral hemorrhage (sICH), favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-3, and mortality, at 90 day and 1-year. Results: After excluding 14 cases with failed access/penetration, a total of 249 patients (mean age of 63.9 years [SD 11.7], 208 [83.5%] male) were included. Basilar artery occlusions were recorded in 179 patients (71.9%) followed by V4 occlusions in 64 patients (25.7%) and PCA occlusions in 6 patients (2.4%). The median baseline NIHSS score was 23 (IQR 12-30) and median PC-ASPECTS was 9 (IQR 7-10). Intravenous thrombolysis was administered in 55 patients (22.1%) while general anesthesia was used in 94/248 patients (37.9%). The median time from onset to puncture time was 320 minutes (IQR 215-496), with a median procedure time of 130 minutes (IQR 89-170). A median number of passes was 1 (IQR 1-2) and successful reperfusion was achieved in 209/249 patients (83.9%). Favorable clinical outcome (90-day mRS 0-3) was achieved in 99/246 patients (40.2%), with mortality affecting 98/246 patients (39.8%). The 24 h post procedural sICH was found in 19/247 patients (7.7%). At 1-year, favorable clinical outcome (mRS 0-3) was achieved in 98/237 patients (41.4%), with mortality affecting 113/236 patients (47.9%). Conclusion: EVT seems to be a safe and effective approach for posterior circulation tandem occlusions. More comparative studies are needed to confirm these results.