Universität zu Köln

Maus, Volker ORCID: 0000-0001-5097-2631, Kalkan, Alev, Kabbasch, Christoph, Abdullayev, Nuran ORCID: 0000-0003-4522-537X, Stetefeld, Henning, Barnikol, Utako Birgit, Liebig, Thomas, Dohmen, Christian, Fink, Gereon Rudolf, Borggrefe, Jan ORCID: 0000-0003-2908-7560 and Mpotsaris, Anastasios ORCID: 0000-0002-1275-8164 (2019). Mechanical Thrombectomy in Basilar Artery Occlusion: Presence of Bilateral Posterior Communicating Arteries is aPredictor of Favorable Clinical Outcome. Clin. Neuroradiol., 29 (1). S. 153 - 161. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1869-1447

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Abstract

BackgroundMechanical thrombectomy (MT) of basilar artery occlusions (BAO) is asubject of debate. We investigated the clinical outcome of MT in BAO and predictors of afavorable outcome.Material and MethodsA total of 104 MTs of BAO (carried out between 2010 and 2016) were analyzed. Favorable outcome as a modified Rankin scale (mRS) 2 at 90days was the primary endpoint. The influence of the following variables on outcome was investigated: number of detectable posterior communicating arteries (PcoAs), patency of basilar tip, completeness of BAO and posterior circulation Alberta Stroke Program early computed tomography score (PC-ASPECTS). Secondary endpoints were technical periprocedural parameters including symptomatic intracranial hemorrhage (sICH).ResultsThe favorable clinical outcome at 90days was 25% and mortality was 43%. The rate of successful reperfusion, i.e. modified thrombolysis in cerebral infarction (mTICI) 2b was 82%. Presence of bilateral PcoAs (area under the curve, AUC: 0.81, odds ratio, OR: 4.2, 2.2-8.2; p< 0.0001), lower National Institute of Health Stroke Scale (NIHSS) on admission (AUC: 0.74, OR: 2.6, 1.3-5.2; p< 0.01), PC-ASPECTS 9 (AUC: 0.72, OR: 4.2, 1.5-11.9; p< 0.01), incomplete BAO (AUC: 0.66, OR: 2.6, 1.4-4.8; p< 0.001), and basilar tip patency (AUC: 0.66, OR: 2.5, 1.3-4.8; p< 0.01) were associated with a favorable outcome. Stepwise logistic regression analysis revealed that the strongest predictors of favorable outcome at 90days were bilateral PcoAs, low NIHSS on admission, and incomplete BAO (AUC: 0.923, OR: 7.2, 3-17.3; p< 0.0001).ConclusionThe use of MT for BAO is safe with high rates of successful reperfusion. Aside from baseline NIHSS and incomplete vessel occlusion, both known predictors of favorable outcome in anterior circulation events, we found that collateral flow based on the presence or absence of PcoAs had adecisive prognostic impact.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Maus, Volker UNSPECIFIED orcid.org/0000-0001-5097-2631 UNSPECIFIED Kalkan, Alev UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Abdullayev, Nuran UNSPECIFIED orcid.org/0000-0003-4522-537X UNSPECIFIED Stetefeld, Henning UNSPECIFIED UNSPECIFIED UNSPECIFIED Barnikol, Utako Birgit UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebig, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Dohmen, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Fink, Gereon Rudolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Borggrefe, Jan UNSPECIFIED orcid.org/0000-0003-2908-7560 UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED orcid.org/0000-0002-1275-8164 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-155743
DOI:	10.1007/s00062-017-0651-3
Journal or Publication Title:	Clin. Neuroradiol.
Volume:	29
Number:	1
Page Range:	S. 153 - 161
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 ENDOVASCULAR THROMBECTOMY; REVASCULARIZATION DEVICE; INTRAVENOUS THROMBOLYSIS; STENT RETRIEVERS; ISCHEMIC-STROKE; RECANALIZATION; EXPERIENCE; INTRAARTERIAL; PREDICTORS Multiple languages Clinical Neurology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15574