Thrombectomy in basilar artery occlusions: impact of number of passes and futile reperfusion.

Autor:	de Havenon A; Department of Neurology, Yale University, New Haven, Connecticut, USA adam.dehavenon@yale.edu., Elhorany M; Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France., Boulouis G; Neuroradiology, Hôpital Sainte-Anne, Paris, France., Naggara O; Neuroradiology, Hôpital Sainte-Anne, Paris, France., Darcourt J; Neuroradiology, CHU de Toulouse, Toulouse, France., Clarençon F; Sorbonne Université, Paris, France.; Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France., Richard S; Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France., Marnat G; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France., Bourcier R; Neuroradiology, Université de Nantes, Nantes, France., Sibon I; CHU de Bordeaux, Bordeaux, France., Arquizan C; Neurology, CHRU Gui de Chauliac, Montpellier, France., Dargazanli C; Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France., Maïer B; Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France., Seners P; Adolphe de Rothschild Ophthalmological Foundation Department of Interventional Neuroradiology, Paris, Île-de-France, France., Lapergue B; Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France., Consoli A; Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.; Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy., Eugene F; Radiologie, CHU Rennes, Rennes, France., Vannier S; Department of Neurology, CHU Rennes, Rennes, Bretagne, France., Caroff J; Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France., Denier C; Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France., Boulanger M; Department of Neurology, CHU Caen, Caen, France., Gauberti M; CHU Caen, Caen, Basse-Normandie, France., Rouchaud A; Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.; Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France., Macian F; Department of Neurology, CHU Limoges, Limoges, France., Rosso C; Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France., Turc G; Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France., Ozkul-Wermester O; Department of Neurology, CHU Rouen, Rouen, France., Papagiannaki C; CHU Rouen, Rouen, Normandie, France., Albucher JF; Neurology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France., Le Bras A; Department of Radiology, CH Bretagne Atlantique, Vannes, France.; CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France., Evain S; Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France., Wolff V; Stroke Unit, Strasbourg University Hospitals, Strasbourg, France., Pop R; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.; Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France., Timsit S; Department of Neurology, CHU Brest, Brest, France., Gentric JC; CHUM Montreal, Montréal, Québec, Canada., Bourdain F; CH Côte Basque, Bayonne, France., Veunac L; Department of Radiology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France., Fahed R; Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada.; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France., Finitsis SN; Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada.; Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Québec, Canada., Gory B; Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 May; Vol. 15 (5), pp. 422-427. Date of Electronic Publication: 2022 Apr 21.
DOI:	10.1136/neurintsurg-2022-018715
Abstrakt:	Background: The number of mechanical thrombectomy (MT) passes is strongly associated with angiographic reperfusion as well as clinical outcomes in patients with anterior circulation ischemic stroke. However, these associations have not been analyzed in patients with basilar artery occlusion (BAO). We investigated the influence of the number of MT passes on the degree of reperfusion and clinical outcomes, and compared outcome after ≤3 passes versus >3 passes. Methods: We used data from the prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry at 18 sites in France. Patients with BAO treated with MT were included. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days. We fit mixed multiple regression models, with center as a random effect. Results: We included 275 patients. Successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) was achieved in 88.4%, and 41.8% had a favorable outcome. The odds ratio for favorable outcome with each pass above 1 was 0.41 (95% CI 0.23 to 0.73) and for recanalization (mTICI 2b-3) it was 0.70 (95% CI 0.57 to 0.87). In patients with ≤3 passes, the rate of favorable outcome in recanalized versus non-recanalized patients was 50.5% versus 10.0% (p=0.001), while in those with >3 passes it was 16.7% versus 15.2% (p=0.901). Conclusions: We found that BAO patients had a significant relationship between the number of MT passes and both recanalization and favorable functional outcome. We further found that the benefit of recanalization in BAO patients was significant only when recanalization was achieved within three passes, encouraging at least three passes before stopping the procedure. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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