The efficacy of mechanical thrombectomy with retrievable stent for acute basilar artery occlusion

Abstract

Objective To evaluate the feasibility and efficacy of mechanical thrombectomy with retrievable stent for stroke patients with acute basilar artery occlusion (BAO). Methods A retrospective review was conducted of 30 cases with BAO admitted to Department of Neurosurgery, Changhai Hospital, the Second Military Medical University during the period from September 2013 to December 2016. 17 cases underwent mechanical thrombectomy by the Solumbra technology, while 13 cases underwent simple stent thrombectomy.The technical feasibility, rate of recanalization, good outcomes at 90 days and procedural complications were evaluated. The changes of National Institutes of Health Stroke Scale (NIHSS) score at 24 hours post procedure, influence of different techniques on recanalization rate and relationship between TOAST (Trial of Org 10172 in Acute Stroke Treatment) types and prognosis were further analyzed. Results Among all 30 cases of BAO in this series, 50% were cardio-embolism of TOAST types. After mechanical thrombectomy with retrievable stent, successfully recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3] was achieved in 87% (26/30) of the patients and good outcome [modified Rankin Scale (mRS) ≤3 at 3 months] was reported in 67% (20/30) of the cases. Compared with preoperative conditions, the NIHSS score at 24 hours post procedure was markedly lower (3 vs. 25, P=0.003). Univariate analysis showed that the Solumbra technology was better than simple stent thrombectomy in terms of successful recanalization rate (69% vs. 30%, P=0.033). The cases of cardio-embolism had greater chances of achieving good outcomes than atherosclerosis (87% vs. 45%, P=0.038). The common surgical complications or adverse events included ectopic embolization, arterial dissection, re-occlusion and hemorrhagic transformation. Our 90-day follow-up study reported the mortality rate of 10% (3/30). Conclusion Mechanical thrombectomy with retrievable stent for BAO is suggested to be safe and feasible, which might be good for improving the rate of one-pass recanalization. Cardiac embolism could be an important factor in predicting the prognosis of patients with BAO after mechanical thrombectomy. Key words: Arterial occlusive diseases; Basilar artery; Stents; Thrombectomy; Treatment outcome