Does Stroke Etiology Influence Outcome in the Posterior Circulation? An Analysis of 112 Consecutive Acute Basilar Occlusion Thrombectomies. (16th November 2020)

• Record Type: Journal Article
• Authors: Sefcik, Roberta K; Tonetti, Daniel; Desai, Shashvat; Jadhav, Ashutosh; Gross, Bradley A
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_260
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Acute basilar artery occlusion (BAO) harbors a more guarded prognosis after thrombectomy as compared to anterior circulation large vessel occlusion (LVO). LVO secondary to intrinsic disease is generally more prevalent in the posterior circulation. Does this in part explain worse clinical outcomes in patients with BAO? METHODS: A prospectively collected comprehensive stroke center database was reviewed and all patients with acute BAO were included. Patients were subdivided into two groups by stroke mechanism and treatment modality - embolic (thrombectomy only) versus intrinsic (thrombectomy + stenting). Analyses were performed comparing groups who underwent thrombectomy only versus those who required stenting. RESULTS: The cohort was comprised of 112 patients, of which 25 were excluded for vertebral ostial disease/tandem lesions. Of the remaining patients, 73 had embolic disease (84%), and 14 had intrinsic disease (16%). There was no significant difference in patient age, presenting NIHSS score, time to presentation, selected medical comorbidities (HTN, HL, DM, AFib), prior stroke, and posterior circulation ASPECTS score. Patients with intrinsic disease were more likely to be active smokers (50% vs 23%, p = 0.05) and more likely to be male (93% vs 52%, p = 0.001). Successful recanalization (TICI 2b/3) was 88% overall and did not differ significantly between the embolic versus intrinsic groups (88% vs 86%, p = 1). Ninety-day good outcome (mRS 0–2) was 37% overall and did not differ significantly between groups (34% vs 46%, p = 0.52). Mortality was 38%; for those with intrinsic disease, it was 15% at ninety days; for those with thromboembolic disease, it was 42% (p = 0.11). CONCLUSION: We present meaningful demographic results for basilar artery occlusive disease, delineating a prevalence of intrinsic disease in 16% of patients, treated via stenting after thrombectomy. Active smoking and male sex were predictors of intrinsic disease. There was no significant difference in revascularization result and outcome results between patients with embolic and those with intrinsic disease, though scrutiny across larger cohorts toward overall mortality is warranted.