Outcome and recanalization rate of tandem basilar artery occlusion treated by mechanical thrombectomy - 18/09/20

Doi : 10.1016/j.neurad.2020.08.004

Mahmoud Elhorany ^a,^b,^c,^d, Grégoire Boulouis ^e, Wagih Ben Hassen ^e, Sophie Crozier ^f, Eimad Shotar ^c, Nader-Antoine Sourour ^c, Stephanie Lenck ^c, Kevin Premat ^a,^c, Robert Fahed ^g, Vincent Degos ^a,^b,^h, Ahmed Mohamed Elhfnawy ^a,^b,^c,ⁱ, Ossama Yassin Mansour ⁱ, El-Sayed Ali Tag El-din ^d, Wael Ahmed Fadel ^d, Sonia Alamowitch ^a,^j, Yves Samson ^a,^f, Olivier Naggara ^e, Frédéric Clarençon ^a,^b,^c,⁎
^a Sorbonne University, Paris VI University, Paris, France
^b GRC-14 Biosfast, Paris VI University, Paris, France
^c Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
^d Department of Neurology, Faculty of Medicine, Tanta University, Egypt
^e INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
^f Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
^g Department of Interventional Neuroradiology, Fondation A. de Rothschild, Paris, France
^h Department of Anaesthesiology, Pitié-Salpêtrière Hospital, Paris, France
ⁱ Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
^j Department of Vascular Neurology, Saint-Antoine University Hospital, Paris, France

^⁎Corresponding author at: Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris 75013, France.Neuroradiology DepartmentPitié-Salpêtrière Hospital47-83 Boulevard de l’HôpitalParis75013France

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 18 September 2020
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Graphical abstract

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Highlights

•	Basilar artery occlusion accounts for 1% of all acute ischemic stroke and 5-10% of those with large vessel occlusions.
•	Tandem basilar artery occlusion is a concomitant basilar artery and extracranial dominant vertebral artery occlusion.
•	Patients with tandem basilar artery occlusion had lower rates of successful recanalization and good clinical outcome.
•	Mortality rate was higher among patients with tandem basilar artery occlusion.

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Abstract

Background

Tandem basilar artery occlusions (tBAO) are defined as concomitant basilar artery and extracranial dominant vertebral artery occlusions. The prognosis of such tBAO treated by mechanical thrombectomy (MT) has been scantly reported.

The purpose of our study was to compare the safety and effectiveness of MT for patients with tBAO compared to those with non-tandem basilar artery occlusions (ntBAO).

Patients and methods

Retrospective analysis of a database of patients who underwent MT at two academic centres. All patients treated for BAO were retrieved. Patients with tBAO, defined as a concomitant BAO and extracranial vertebral artery (VA) occlusion or severe stenosis ≥70% (V1 or proximal V2 segment) were compared with patients with ntBAO.

Results

A total of 15 patients with tBAO and 74 patients with ntBAO were enrolled. Successful reperfusion (modified thrombolysis in cerebral infarction score ≥2b) was obtained in 73.3% versus 90.5% (OR = 0.29, 95%CI: 0.07–1.15), good clinical outcome (3-months modified Rankin scale ≤2) was reached by 26.7% versus 32.4% (OR = 0.76; 95% CI: 0.24–2.63) and mortality at 3-months was 46.7% versus 31% (OR = 1.94; 95%CI: 0.63–6) of patients with tBAO versus ntBAO, respectively. Two patients (13.3%) with tBAO and three (4%) with ntBAO had symptomatic intracranial haemorrhage (OR = 3.64; 95% CI: 0.55–24).

Conclusion

Mechanical thrombectomy for patients with tandem basilar artery occlusion tends to be associated with lower rates of successful reperfusion and good clinical outcome, and higher rate of mortality. Larger multicentre studies are warranted to better precise the proper selection and management of such patients.

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Abbreviations : tBAO, MT, ntBAO, VA, AIS, LVO, BA, NIHSS, mRS, mTICI, BAO, SICH, DSA