Abstract
Background and Purpose: Endovascular treatment (EVT) is one of the promising treatment options in patients with intracranial atherosclerotic disease (ICAD)-related basilar artery occlusion (BAO). In this study, we compared the safety and efficacy of direct angioplasty (DA) with stent-retriever thrombectomy (SRT) with or without rescue treatment in ICAD-related BAO.Methods: We retrospectively evaluated 187 patients who underwent EVT for BAO from January 2012 to July 2018. We identified patients who underwent EVT due to ICAD-related BAO. Patients who accepted SRT with or without rescue treatment were classified into the SRT group. Patients treated with DA with or without stent placement were classified into DA group. Clinical and laboratory findings and outcomes were compared between groups.Results: A total of 108 patients were enrolled, among them 77 underwent SRT and 31 underwent DA; 61 (79.2%) SRT group patients underwent angioplasty with or without stent placement. Compared with patients in the SRT group, those in the DA group experienced a significantly shorter procedure time [60 min (60–120 min) vs. 120 min (60–120 min); p = 0.038] and a lower number of device passes [2 passes (1–2 passes) vs. 3 passes (2–4 passes); p < 0.001]. No significant differences in balloon angioplasty (35.5 vs. 22.1%; p = 0.150), emergent stent placement (64.5 vs. 57.1%; p = 0.481), successful recanalization (93.5 vs. 85.7%; p = 0.340), embolization in distal or new territory (3.2 vs. 9.1%, p = 0.314), and reocclusion (22.6 vs. 9.1%; p = 0.109) among DA and SRT groups were found. Additionally, no differences in symptomatic intracranial hemorrhage incidence [adjusted odds ratio (OR), 0.74; 95% CI, 0.06–9.44; p = 0.815], functional independence (adjusted OR, 1.44; 95% CI, 0.50–4.16; p = 0.497), and mortality rate (adjusted OR, 0.36; 95% CI, 0.06–2.04; p = 0.247) were noted among groups.Conclusions: In certain patients with ICAD-related BAO, DA may shorten procedure time and reduce required device passes compared to SRT. In this study, DA was retrospectively found to be of similar safety and efficacy as SRT.
Highlights
Acute ischemic stroke secondary to basilar artery occlusion (BAO) is associated with high rates of disability and mortality [1,2,3]
We retrospectively evaluated the clinical data of patients who were diagnosed with acute stroke attributable to BAO and who consecutively underwent endovascular therapy (EVT) at Beijing Tiantan Hospital from January 2012 to July 2018
The Solitaire AB stent retriever was permanently detached in 16 patients, whereas Apollo and Wingspan stents were alternatively separately used in 24 and 16 patients, respectively
Summary
Acute ischemic stroke secondary to basilar artery occlusion (BAO) is associated with high rates of disability and mortality [1,2,3]. The endovascular treatment vs standard medical treatment for vertebrobasilar artery occlusion (BEST) study did not reveal any difference in favorable outcomes among patients who underwent endovascular therapy (EVT) compared to standard medical therapy alone, those findings may have been related to the early termination of the experiment due to crossgroup recognition bias and poor patient compliance [7]. Another recently published cohort study reported EVT to associate with a significantly better functional outcome than standard medical therapy among patients with acute BAO [8]. We compared the safety and efficacy of direct angioplasty (DA) with stent-retriever thrombectomy (SRT) with or without rescue treatment in ICAD-related BAO
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