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Mierzwa AT, Prologo-Richardson P, Kasab SA, Nelson A, Gutierrez SO, Vivanco-Suarez J, Farooqui M, Jadhav AP, Desai S, Toth G, Alrohimi A, Nguyen TN, Klein P, Abdalkader M, Salahuddin H, Wilseck Z, Pandey A, Koduri S, Vora N, Aladamat N, Gharaibeh K, Afreen E, Zaidi S, Jumaa M. Control-matched octo/nonagenarian outcomes in acute basilar artery occlusions treated with mechanical thrombectomy-analysis of the PC-SEARCH thrombectomy registry. Interv Neuroradiol 2024:15910199241265397. [PMID: 39043366 DOI: 10.1177/15910199241265397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Age is often used as a predictor in determining outcomes in large vessel occlusions treated with mechanical thrombectomy. However, limited data exist for octo/nonagenarian outcomes compared to younger individuals in acute basilar artery occlusions treated with thrombectomy. METHODS Patient data were obtained from the PC-SEARCH Thrombectomy Registry which consists of 444 acute basilar artery occlusions treated with mechanical thrombectomy. Individuals were dichotomized based on age (>80 and ≤80 years old). Primary outcome was defined as modified Rankin Scale of 0-3 at 90 days. Logistic and multivariate regression, as well as control-matched analysis, were performed. RESULTS There were 373 and 71 patients in the younger and older cohorts, respectively. Gender, ethnicity, smoking status, atrial fibrillation, and coronary artery disease were noted to be significantly different between cohorts. At 90 days, 178 (47.7%) and 23 (32.4%) patients achieved primary outcome at 90 days (p = 0.02), however, after controlling for potentially confounding factors this association lost significance (OR 0.50 95% CI 0.24-1.05; p = 0.07). There were 84 patients included in the control matched analysis and demonstrated no significant differences on multivariate analysis between cohorts (OR 0.68 95% CI 0.25-1.84; p = 0.45). INTERPRETATION Octa/nonagenarians presenting with an acute basilar artery occlusion treated with mechanical thrombectomy can achieve acceptable rates of favorable functional outcomes compared to younger individuals with similar baseline demographic and stroke characteristics.
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Affiliation(s)
- Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Neurology, Promedica Stroke Network, Toledo, OH, USA
| | - Paige Prologo-Richardson
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ashley Nelson
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Juan Vivanco-Suarez
- Department of Cerebrovascular and Neurointerventional Lab, University of Iowa, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Cerebrovascular and Neurointerventional Lab, University of Iowa, Iowa City, IA, USA
| | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shashvat Desai
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gabor Toth
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anas Alrohimi
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, MA, USA
| | - Piers Klein
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, MA, USA
| | - Mohamad Abdalkader
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, MA, USA
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, CA, USA
| | - Zachary Wilseck
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Nirav Vora
- Department of Neurology, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ehad Afreen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Neurology, Promedica Stroke Network, Toledo, OH, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Neurology, Promedica Stroke Network, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Neurology, Promedica Stroke Network, Toledo, OH, USA
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Weyland CS, Mutke MA, Zimmermann-Miotk A, Schmitt N, Chen M, Schönenberger S, Möhlenbruch M, Bendszus M, Jesser J. Clinical outcome and outcome prediction of octogenarians with acute basilar artery occlusion and endovascular stroke treatment compared to younger patients. Front Neurol 2023; 14:1266105. [PMID: 37840915 PMCID: PMC10570514 DOI: 10.3389/fneur.2023.1266105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Background and aims Octogenarians are underrepresented in recently published studies that showed the benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients (YPs) and identify independent outcome predictors. Methods This is a retrospective, single-center analysis of patients treated for BAO with EST from January 2013 until June 2021 in a tertiary stroke center. Octogenarians (80-89 years) were compared to YPs. A study endpoint was a favorable clinical outcome as per the modified Rankin Scale (mRS 0-3), 90 days after stroke onset. The study groups were compared using univariate analysis, and a multivariable logistic regression analysis was performed to define independent predictors for favorable and unfavorable (mRS 5-6) clinical outcomes. Results In this study cohort, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS [median, interquartile range (IQR): 2, 1-3 octogenarians vs. 0, 0-1 YP, p < 0.001] and a comparable National Institutes of Health Stroke Scale (NIHSS) before EST (median, IQR: 21, 10-38 vs. 20, 8-35 in YP, p = 0.487). They showed a comparable rate of favorable outcome (mRS 0-3, 90 days, 23.0 vs. 25.6% in YP, p = 0.725), but were less often functionally independent (mRS 0-2: 10.8% in octogenarians vs. 23.0% in YP, p = 0.049). The rate of unfavorable clinical outcome was comparable (mRS 5-6, n = 40, 54.1% in octogenarians vs. n = 64, 54.7% in YP, p = 0.831). A baseline NIHSS was an independent predictor for clinical outcome in YPs [e.g., for unfavorable clinical outcome: odds ratio (OR) 1.061, confidence interval (CI) 1.027-1.098, p = 0.005] and for favorable clinical outcome in octogenarians. Pre-stroke mRS predicted favorable outcomes in octogenarians (OR 0.54, CI 0.30-0.90, p = 0.0291), while age predicted unfavorable outcomes in YPs (OR 1.045, CI 1.011-1.086, p = 0.0137). Conclusion Octogenarians with acute BAO eligible for EST are as likely to achieve a favorable outcome as YPs, and the rate of death or severe disability is comparable. The admission NIHSS is an independent predictor for favorable and unfavorable outcomes in YP and for favorable outcomes in octogenarians. In this study cohort, pre-stroke mRS predicted favorable outcomes in octogenarians while age predicted an unfavorable outcome in YPs.
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Affiliation(s)
- Charlotte Sabine Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
- Department of Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Matthias Anthony Mutke
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
- Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Amanda Zimmermann-Miotk
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
| | - Niclas Schmitt
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
| | - Min Chen
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Wuürttemberg, Germany
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Gunasekera L, Mitchell P, Dowling RJ, Bush S, Yan B. Functional recovery continues beyond 3 months post-basilar artery thrombectomy: A retrospective cohort study. CNS Neurosci Ther 2023. [PMID: 36942501 DOI: 10.1111/cns.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Untreated basilar artery occlusion (BAO) carries 70% mortality. Guidelines recommend thrombectomy with or without thrombolysis. AIM We compared Modified Rankin Scores (mRS) at 3 and 12 months post thrombectomy to determine benefit of long-term follow up. METHODS Retrospective, single centre analysis of BAO thrombectomies between 2015 and 2019. Inclusion criteria were symptomatic BAO on CT angiography, absent early ischemic changes, premorbid independence and intervention within 24 h. All received stroke ward care. Results were analysed with simple statistics and binary logistic regression as appropriate. RESULTS Of 82 patients: most were male (61%, 50/82) with median age 68 years (IQR 17 years) and median NIHSS 14 (IQR 15). Median door-to-puncture time was 42 min (IQR 72 min). Total deaths were 34.1% (28/82) at 3 months, and 37.8% (31/82) at 12 months. Of 51 patients alive at 12 months: 41% (21/51) had improved mRS, 16% (8/51) had worse mRS and 43% (22/51) had unchanged mRS, compared to 3 months. Improvements to mRS were: one point in 57.1% (14/21), two points in 28.9% (6/21) and three points in 4.8% (1/21). Nursing home admission was avoided in 11.8% (6/51) who improved from mRS4. Increased age was associated with decreased likelihood of reaching the primary outcome OR 0.87, 95% CI 0.76-0.99 (p value = 0.03). CONCLUSION Over a quarter of patients improved beyond 3 months. Future studies should adopt long-term follow up as primary outcome.
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Affiliation(s)
- Lakshini Gunasekera
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Peter Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Richard J Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven Bush
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bernard Yan
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia
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Luo W, Huang W, Zhang M, Liu X, Guo Z, Zhou P, Wang L, Fu X, Yang S, Zhang S, Zhou Z, Zhang M, Yuan J, Liu S, Song J, Qiu Z, Sang H, Li F, Zi W, Wu D, Liu W, Yang Q. Endovascular intervention for basilar artery occlusion in the elderly. Ther Adv Neurol Disord 2021; 14:17562864211000453. [PMID: 33912242 PMCID: PMC8047973 DOI: 10.1177/17562864211000453] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background: To date, few data have been reported on clinical outcomes following interventions in elderly populations with acute basilar artery occlusion. Using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR), we evaluated the efficacy and safety of intervention and determined predictors of outcomes among elderly patients in China. Methods: Patients from January 2014 to May 2019 were dichotomized into elderly (75 years or older) and nonelderly patients (under 75 years). Pearson’s Chi-square test and multivariate logistic regression were performed to assess 90-day favorable functional outcome (defined as a modified Rankin scale score of 0–3), mortality and symptomatic intracranial hemorrhage between intervention and conservative cohorts in elderly patients. Results: Among the 829 patients in the BASILAR, 182 patients aged 75 years or older were analyzed. These patients were divided into intervention (127 patients) and conservative (55 patients) cohorts. Compared with the conservative cohort, the intervention cohort presented more frequently with a favorable functional outcome (28.3% versus 12.7%; p = 0.023) and with a decreased mortality (54.3% versus 76.4%; p = 0.005). There was no difference in symptomatic intracranial hemorrhage (4.7% versus 0, p = 0.235). Multivariate analysis indicated that intervention was associated with favorable functional outcome (adjusted odds ratio, 0.262; 95% confidence interval, 0.088–0.778, p = 0.016) and lower mortality (adjusted odds ratio, 0.257; 95% confidence interval, 0.109–0.606, p = 0.002). In the intervention cohort, initial National Institutes of Health Stroke Scale (NIHSS) score and occlusion site were associated with functional outcome, and initial NIHSS score and recanalization were associated with mortality. Conclusions: Although the overall outcome following intervention was worse with age, intervention was more effective and safer than conservative treatment for elderly Chinese patients with basilar artery occlusion. Predictors of desirable outcome in elderly patients undergoing intervention included lower initial NIHSS score, occlusion site and successful recanalization. Clinical Trial Registration-URL: http://www.chictr.org. Unique identifier: ChiCTR-1800014759
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Affiliation(s)
- Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenguo Huang
- Department of Neurology, Maoming Traditional Chinese Medicine Hospital, Maoming, China
| | - Min Zhang
- Department of Neurology, Maoming Traditional Chinese Medicine Hospital, Maoming, China
| | - Xing Liu
- Department of Medicine, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Peiyang Zhou
- Department of Neurology, The First People's Hospital of Xiangyang, Xiangyang, China
| | - Li Wang
- Department of Neurology, The Third People's Hospital of Zigong, Zigong, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Shiquan Yang
- Department of Neurology, The 902th Hospital of The Chinese People's Liberation Army, Bengbu, China
| | - Shuai Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, No. 215 Zhongshan Avenue, Qiaokou District, Wuhan 430000, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), No. 183 Xinqiao Main Street, Shapingba District, Chongqing, 400037, China
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Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Mosimann PJ, Michel P, Hajdu S, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Pereira VM, Gralla J, Fischer U. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. J Neurointerv Surg 2019; 11:1174-1180. [PMID: 31239331 PMCID: PMC6902072 DOI: 10.1136/neurintsurg-2018-014516] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based. OBJECTIVE To compare patients' outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT. METHODS In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms. RESULTS MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 - 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 - 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO. CONCLUSIONS In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR. TRIAL REGISTRATION NUMBER NCT03496064.
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Affiliation(s)
- Thomas Raphael Meinel
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Leonidas Panos
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal J Mosimann
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, CHUV Lausanne, Lausanne, Switzerland
| | - Steven Hajdu
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Laurent Pierot
- Department of Neuroradiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Matthias Gawlitza
- Department of Neuroradiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Vitor M Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bouslama M, Haussen DC, Aghaebrahim A, Grossberg JA, Walker G, Rangaraju S, Horev A, Frankel MR, Nogueira RG, Jovin TG, Jadhav AP. Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke. Stroke 2017; 48:3252-3257. [PMID: 29089457 DOI: 10.1161/strokeaha.117.018270] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. METHODS We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. RESULTS A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P=0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P<0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36-85.96; P=0.025) were associated with good outcome. CONCLUSIONS In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.
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Affiliation(s)
- Mehdi Bouslama
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Diogo C Haussen
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Amin Aghaebrahim
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Jonathan A Grossberg
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Gregory Walker
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Srikant Rangaraju
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Anat Horev
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Michael R Frankel
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Raul G Nogueira
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Tudor G Jovin
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Ashutosh P Jadhav
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.).
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Gory B, Eldesouky I, Sivan-Hoffmann R, Rabilloud M, Ong E, Riva R, Gherasim DN, Turjman A, Nighoghossian N, Turjman F. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review. J Neurol Neurosurg Psychiatry 2016; 87:520-5. [PMID: 25986363 DOI: 10.1136/jnnp-2014-310250] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/08/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Basilar artery occlusion (BAO) remains one of the most devastating subtypes of stroke with high mortality and poor outcome. Early recanalisation is the most powerful predictor of favourable outcome in patients with stroke, and may be improved with mechanical thrombectomy using stent retriever devices. However, the benefit in functional outcome and safety of stent retrievers are not yet well known. The aim of this study was to assess efficacy and safety profiles of stent retriever thrombectomy in BAO patients with stroke. METHODS We analysed data retrospectively from our consecutive clinical series and conducted a systematic review and meta-analysis of all previous studies of stent retriever thrombectomy in BAO patients with stroke between November 2010 and April 2014. RESULTS From March 2010 to March 2013, 22 patients with acute BAO were treated with a Solitaire stent retriever in our series. Favourable outcome was significantly associated with younger age and distal BAO. The literature search identified 15 previous studies involving a total of 312 subjects. In the meta-analysis, including our series data, the recanalisation rate (Thrombolysis In Cerebral Infarction (TICI) score ≥ 2b) reached 81% (95% CI 73% to 87%). The rate of symptomatic intracranial haemorrhage was 4% (95% CI 2% to 8%), favourable outcome (modified Rankin Scale (mRS) ≤ 2 at 3 months) was found in 42% (95% CI 36% to 48%) and mortality rate was 30% (95% CI 25% to 36%). CONCLUSIONS Stent retriever thrombectomy is a safe treatment modality for patients with stroke presenting with BAO. Although the stent retrievers showed a good recanalisation rate, there are currently no randomised clinical trials to assess its clinical efficacy in comparison with the reference treatment.
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Affiliation(s)
- Benjamin Gory
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Islam Eldesouky
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Rotem Sivan-Hoffmann
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Murielle Rabilloud
- Department of Biostatitics, UMR 5558, Hospices Civils de Lyon, Lyon, France
| | - Elodie Ong
- Department of Neurology, Stroke Unit, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Roberto Riva
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Dorin Nicolae Gherasim
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Alexis Turjman
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Norbert Nighoghossian
- Department of Neurology, Stroke Unit, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Bron, France
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Sairanen T, Strbian D, Ruuskanen R, Silvennoinen H, Salonen O, Lindsberg PJ. Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion. Eur J Neurol 2014; 22:493-9. [PMID: 25482105 DOI: 10.1111/ene.12597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to determine factors associated with symptomatic intracranial haemorrhage (sICH) in basilar artery occlusion patients treated with intravenous thrombolysis (IVT) and adjuvant anticoagulant therapy. METHODS A registry of 176 consecutive patients with angiography-proven basilar artery occlusion who received IVT with alteplase and heparin between 1995 to 2013 was assessed. Post-treatment sICH was evaluated with the European Cooperative Acute Stroke Study II criteria. Unfavourable outcome was defined as a modified Rankin Scale score of 3-6 at 3 months. RESULTS Twenty-four patients developed sICH (13.6%, sICH+), all of whom had unfavourable outcome and only two (8.3%) sICH+ patients survived. On admission, sICH+ patients more frequently had extensive ischaemic changes defined as posterior circulation Acute Stroke Prognosis Early CT Score (PC-ASPECTS) < 8 (50% vs. 27% in sICH-, P = 0.031) and lower platelet counts (183 vs. 218 E9/l; P = 0.011). They also had higher systolic blood pressure (SBP) (median 160 vs. 147 mmHg, P = 0.034) immediately after IVT. In multivariable regression analysis, lower platelet values [odds ratio (OR) 0.99, 95% confidence interval (CI) 0.97-0.996; P = 0.006], PC-ASPECTS < 8 on admission (OR 3.6, 95% CI 1.3-10.3; P = 0.017) and higher SBP after treatment (OR 1.03, 95% CI 1.01-1.05; P = 0.017) were independently associated with sICH. Ninety per cent of the sICHs occurred within 48 h from IVT/anticoagulation treatment. No differences in activated partial thrompoplastin times prior to or after the treatment were observed between sICH+ and sICH- patients. CONCLUSIONS The risk of sICH was largely determined by extension of ischaemic changes on admission computed tomography. Clinically relevantly, also higher post-thrombolytic SBP as described earlier and lower perithrombolytic platelet counts do increase the risk, a finding requiring confirmation in other patient series.
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Affiliation(s)
- T Sairanen
- Department of Neurology, University of Helsinki, Helsinki, Finland
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Leslie-Mazwi TM, Chandra RV, Simonsen CZ, Yoo AJ. Elderly patients and intra-arterial stroke therapy. Expert Rev Cardiovasc Ther 2013; 11:1713-23. [PMID: 24195443 DOI: 10.1586/14779072.2013.839219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ischemic stroke disproportionately affects the elderly, particularly those over the age of 80 years. Rates of stroke are expected to increase over the next several decades due to increasing numbers of elderly individuals, making understanding stroke treatment in this population an imperative. The only proven acute stroke therapy is early reperfusion, accomplished through intravenous or intra-arterial means. Intra-arterial stroke therapy (IAT) offers higher recanalization rates than intravenous tissue plasminogen activator, but has yet to show clear superiority over intravenous tissue plasminogen activator alone. Existing data suggest that elderly stroke patients suffer worse outcomes following IAT, despite similar rates of recanalization and symptomatic intracranial hemorrhage. This article reviews the application of IAT in the elderly population and summarizes the available studies that investigate the response of elderly patients to IAT.
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Affiliation(s)
- Thabele M Leslie-Mazwi
- Neuroendovascular, Neurologic Critical Care, Massachusetts General Hospital, Boston, USA
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