Abstract
Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0–0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0–0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33–16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16–3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.
Highlights
Mechanical thrombectomy (MT) is currently the gold standard for the treatment of ischemic stroke due to large vessel occlusion (LVO)
The aim of our study is to analyze the outcomes of patients with posterior circulation LVO (pc-LVO) and low baseline National Institute of Health stroke scale (NIHSS) score (≤10) who underwent MT and to identify predictive factors of favorable outcome in this subgroup of patients, since the scientific evidence regarding this specific subgroup of patients are weak
The threshold for the definition of mild neurological impairment in hemispheric stroke does not seem appropriate and other authors have suggested that the NIHSS cutoff that most accurately predicts outcome is 4 points higher in anterior circulation compared to posterior circulation infarctions, suggesting a poor outcome in patients with posterior circulation strokes and low NIHSS scores [17]
Summary
Mechanical thrombectomy (MT) is currently the gold standard for the treatment of ischemic stroke due to large vessel occlusion (LVO). Current guidelines in basilar artery occlusion recommend the use of recombinant tissue plasminogen activator (rtPA) within 4.5 h of symptom onset, while mechanical thrombectomy with stent retrievers can be reasonable for carefully selected patients with acute ischemic stroke in whom treatment can be initiated (groin puncture) within 6 h of symptom onset, and in very selected patients beyond 6 h from symptom onset. In both cases the class of recommendations is IIb, and the level of evidence is low (respectively C-LD: Non randomized observational studies with limitations in design or execution or Metanalysis of such studies; and B-R: nonrandomized studies). The administration of rtPA should not delay the possibility of MT [1]
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