A single-center experience of endovascular treatment in subtypes of basilar artery occlusion: Embolization caused by tandem vertebral artery stenosis may be associated to better outcomes.
Jiang L, Yang JH, Ruan J, Xia WQ, Huang H, Zhang H, Chen TW, Li LF, Yin CG.
World neurosurgery. 2021; ():

Abstract

OBJECTIVE: Basilar artery occlusion (BAO) is a severe condition with high mortality. However, the surgical procedures and outcomes of BAO with different pathologic subtypes have not been fully clarified. This study aimed to compare the surgical procedures and clinical outcomes of mechanical thrombectomy (MT) in different subtypes of BAO. METHODS: Eighty-six patients with acute BAO receiving endovascular treatment (EVT) between October 2015 and July 2019 were retrospectively analyzed and classified into three groups: pure embolism (group 1), arterial-arterial embolism from the steno-occlusion of the tandem vertebral artery (VA) (group 2), and in situ atherosclerotic thrombosis (ISAT) (group 3). Recanalization rates, procedure times, surgical characteristics, and clinical outcomes were analyzed. RESULTS: Groups 1, 2, and 3 included 33 (38.4%), 17 (19.8%), and 36 (41.9%) patients, respectively. The overall successful recanalization rate was 95.3% and the good outcome rate was 61.6%. The procedure time in group 1 was shorter than that in groups 2 and 3 (P< 0.001). The clinical good outcome rate was higher in group 2 than in group 1 (88.2% vs. 54.5%; P = .017). Groups 1 and 3 had similar good outcome rates (54.5% vs. 55.6%; P = 0.933). Twenty-seven patients received stent angioplasty, 10/17 in group 2 (58.8%) and 17/36 in group 3 (47.2%). CONCLUSIONS: The outcome of EVT for BAO varies among groups with different pathologic mechanisms. Patients with embolism from tandem VA steno-occlusion achieved the best outcomes. Rescue treatment was more common in embolic BAO with tandem VA steno-occlusion and BAO with ISAT. CI - Copyright (c) 2021. Published by Elsevier Inc.



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