Universität zu Köln

Siebert, Eberhard ORCID: 0000-0001-7395-6546, Bohner, Georg, Zweynert, Sarah, Maus, Volker, Mpotsaris, Anastasios ORCID: 0000-0002-1275-8164, Liebig, Thomas and Kabbasch, Christoph (2019). Revascularization Techniques for Acute Basilar Artery Occlusion Technical Considerations and Outcome in the Setting of Severe Posterior Circulation Steno-Occlusive Disease. Clin. Neuroradiol., 29 (3). S. 435 - 444. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1869-1447

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Abstract

Purpose To describe the clinical and radiological characteristics, frequency, technical aspects and outcome of endovascular treatment of acute basilar artery occlusion (ABO) in the setting of vertebrobasilar steno-occlusive disease. Methods Retrospective analysis of databases of two universitary stroke centers including all consecutive patients from January 2013 until May 2017 undergoing thrombectomy for a) acute stroke due to basilar artery occlusion and either significant basilar artery stenosis or vertebral artery stenosis/occlusion as well as b) presumed embolic basilar artery occlusions. Demographics, stroke characteristics, time metrics, recanalization results and outcome were recorded. Interventional strategies were evaluated concerning the thrombectomy technique, additional angioplasty, type of approach with respect to lesion pattern (ipsilateral to steno-occlusive VA lesion: dirty road or contralateral: clean road) and sequence of actions. Results Out of 157 patients treated for ABO 38 (24.2%) had associated significant vertebrobasilar steno-occlusive lesions. An underlying significant basilar artery stenosis was present in 23.7% and additionally significant steno-occlusive vertebral lesions were present in 81.5%. Thrombectomy was performed with primary aspiration in 15.8% and with stent-retrievers in 84.2%. Successful revascularization (TICI 2b-3) was achieved in 86.8%. In 52.6% additional stent angioplasty was performed, in 7.9% balloon angioplasty only. The clean road approach was used in 22.5% of cases, the dirty road in 77.4%. Final modified Rankin scale (mRS) was 0-2 in 6 patients (15.8%) and 3-5 in 32 (84.2%). The in-hospital mortality was 36.8%. There were no statistically significant differences in outcome compared to presumed cases of embolisms. Conclusion Endovascular treatment of ABO with underlying significant vertebrobasilar steno-occlusive lesions is effective and reasonably safe. Specific procedural strategies apply depending on individual patient pathology and anatomy. Although high rates of recanalization can be achieved, outcomes tend to be poor.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Siebert, Eberhard UNSPECIFIED orcid.org/0000-0001-7395-6546 UNSPECIFIED Bohner, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Zweynert, Sarah UNSPECIFIED UNSPECIFIED UNSPECIFIED Maus, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED orcid.org/0000-0002-1275-8164 UNSPECIFIED Liebig, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-142567
DOI:	10.1007/s00062-018-0683-3
Journal or Publication Title:	Clin. Neuroradiol.
Volume:	29
Number:	3
Page Range:	S. 435 - 444
Date:	2019
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1869-1447
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE VERTEBROBASILAR OCCLUSION; MECHANICAL THROMBECTOMY; ENDOVASCULAR THERAPY; ANGIOPLASTY Multiple languages Clinical Neurology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14256