J Cerebrovasc Endovasc Neurosurg.  2013 Sep;15(3):137-144. 10.7461/jcen.2013.15.3.137.

Endovascular Mechanical Thrombectomy in Basilar Artery Occlusion: Initial Experience

• Park BS
• Kang CW
• Kwon HJ
• Choi SW
• Kim SH
• Koh HS
• Youm JY
• Song SH

• KMID: 1491430
• DOI: http://doi.org/10.7461/jcen.2013.15.3.137

Abstract

OBJECTIVE
This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion.
MATERIALS AND METHODS
We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III.
RESULTS
Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B.
CONCLUSION
Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.

Keyword

Basilar artery occlusion; Endovascular mechanical thrombectomy; Therapeutic time window; Recanalization

MeSH Terms

Basilar Artery
Cerebral Infarction
Endovascular Procedures
Humans
National Institutes of Health (U.S.)
Retrospective Studies
Stents
Stroke
Suction
Thrombectomy
Thrombosis

Figure

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  Fig. 1 (A) The angiogram shows occlusion of the basilar artery. (B) After placing the Penumbra system at the occlusion site, suction was performed and partial recanalization is shown. (C) Endovascular mechanical thrombectomy using the Penumbra system was carried out again and follow up angiogram shows complete recanalization. (D) Thrombus is pulled out by the Penumbra system.

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  Fig. 2 (A) Initial angiogram in the anteroposterior plane shows basilar artery occlusion (thrombolysis in cerebral infarction grade 0). (B) Cerebral angiogram after temporary deployment of the Solitaire stent shows sufficient coverage and transient flow restoration of the occluded segment. (C) After retrieval of the stent, complete recanalization is shown. (D) Thrombus is trapped by the stent.

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