Endovascular Treatment for Acute Basilar Artery Occlusion: A Comparison of Arteriosclerotic, Embolic and Tandem Lesions

Cardiovasc Intervent Radiol. 2021 Dec;44(12):1954-1963. doi: 10.1007/s00270-021-02994-z. Epub 2021 Nov 5.

Abstract

Purpose: To evaluate the safety and efficacy of endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to intracranial atherosclerosis-related basilar artery occlusion (ICAS-related BAO) by comparison with embolic and tandem occlusion.

Methods: We retrospectively reviewed consecutive patients with AIS due to BAO who underwent EVT. Patients were assigned to the ICAS-related group and embolic group, and tandem group based on the etiology. Baseline data, procedural details, and clinical outcomes were compared between the three groups.

Results: A total of 100 patients (ICAS-related group: 31; embolic group: 41; tandem group: 28) were included. No significant difference was observed in the successful reperfusion (mTICI 2b or 3), but the procedural time differed significantly (60 min vs. 43 min vs. 60 min, P = 0.010). There were no differences in the different intracranial hemorrhage grades among the three groups (P = 0.134). After adjusting for baseline differences, there was no significant difference in pairwise comparisons regarding favorable outcome (mRS 0-2), moderate outcome (mRS 0-3), and mortality.

Conclusions: Endovascular treatment for patients with acute ICAS-related BAO had equal efficacy and safety compared with embolic BAO and tandem BAO. Primary endovascular treatment and rescue modalities were effective treatments for acute ICAS-related BAO.

Keywords: Acute ischemic stroke; Basilar artery occlusion; Embolism; Endovascular treatment; Intracranial atherosclerosis; Tandem occlusion.

MeSH terms

  • Basilar Artery / diagnostic imaging
  • Brain Ischemia*
  • Endovascular Procedures*
  • Humans
  • Retrospective Studies
  • Stroke*
  • Thrombectomy
  • Treatment Outcome