Thrombectomy for Basilar Artery Occlusion with Mild Symptoms

被引：4

作者：

Guenego, Adrien ^{[1
,2
]}

Dargazanli, Cyril ^{[3
]}

Weisenburger-Lile, David ^{[4
]}

Gory, Benjamin ^{[5
,6
]}

Richard, Sebastien ^{[7
,8
]}

Ducroux, Celina ^{[1
]}

Piotin, Michel ^{[1
]}

Blanc, Raphael ^{[1
]}

Labreuche, Julien ^{[9
]}

Lucas, Ludovic ^{[10
]}

Aubertin, Mathilde ^{[1
]}

Benali, Amel ^{[3
]}

Bourcier, Romain ^{[11
]}

Detraz, Lili ^{[11
]}

Vannier, Stephane ^{[12
]}

Guillen, Maud ^{[12
]}

Eugene, Francois ^{[13
]}

Walker, Gregory ^{[14
,15
,16
]}

Lun, Ronda ^{[14
,15
]}

Consoli, Arturo ^{[17
]}

Lapergue, Bertrand ^{[4
]}

Fahed, Robert ^{[1
,14
,15
]}

机构：

[1] Fdn Rothschild Hosp, Dept Intervent Neuroradiol, Paris, France

[2] Erasme Univ Hosp, Dept Intervent Neutoradiol, Brussels, Belgium

[3] Ctr Hosp Univ Gui de Chauliac, Dept Neurnradiol, Montpellier, France

[4] Foch Hosp, Neurovasc Unit, Suresnes, France

[5] Univ Lorraine, Dept Diagnost & Therapeut Neuroradiol, CHRU Nancy, Nancy, France

[6] Univ Lorraine, INSERM U1254, IADI, Nancy, France

[7] Univ Lorraine, Dept Neurol, Stroke Unit, CHRU Nancy, Nancy, France

[8] CHRU Nancy, INSERM U1116, Nancy, France

[9] Univ Lille, CHU Lille, ULR METRICS Evaluat Technol Sante & Prat Med 2694, Lille, France

[10] CHU Bordeaux, Neurovasc Unit, Bordeaux, France

[11] Univ Nantes, Dept Diagnost & Therapeut Ncuroradol, Univ Hosp Nantes, Inserm 1087,CNRS,Inst Thorax, Nantes, France

[12] Ctr Hosp Univ Pontchaillou, Neurovasc Unit, Rennes, France

[13] Ctr Hosp Univ Pontchaillou, Dept Neuroradial, Rennes, France

[14] Ottawa Hosp, Ottawa Hosp Res Inst, Dept Med, Div Neurol, Ottawa, ON, Canada

[15] Univ Ottawa, Ottawa, ON, Canada

[16] Univ British Columbia, Royal Columbian Hosp, Dept Med, Div Neurol, New Westminster, BC, Canada

[17] Foch Hosp, Dept Neuroradiol, Suresnes, France

来源：

WORLD NEUROSURGERY | 2021年 / 149卷

关键词：

Endovascular recanalization; Mild symptoms; Thrombectomy; Stroke; LARGE VESSEL OCCLUSION; HEALTH-CARE PROFESSIONALS; ACUTE ISCHEMIC-STROKE; ENDOVASCULAR THERAPY; VERTEBROBASILAR OCCLUSION; MECHANICAL THROMBECTOMY; EARLY MANAGEMENT; 2018; GUIDELINES; OUTCOMES;

D O I：

10.1016/j.wneu.2021.02.010

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND OBJECTIVE: To evaluate outcomes of thrombectomy in patients with a basilar artery occlusion (BAO) and mild symptoms, defined by an initial National Institutes of Health Stroke Scale (NIHSS) score <= 6. METHODS: We performed a retrospective analysis of a multicenter prospective cohort of consecutive patients with acute ischemic stroke with BAO who underwent thrombectomy. We compared baseline and procedural characteristics, as well as outcomes between patients with BAO with an NIHSS score <= 6 and >6. Multivariate analyses were performed to determine baseline and procedural predictors of good outcome (modified Rankin Scale score 0-2) among patients with an NIHSS score <= 6. RESULTS: A total of 269 patients were included: 50 (19%) had an initial NIHSS score <= 6 and 219 (81%) had an NIHSS score >6. Patients with mild strokes (NIHSS score <= 6) had better outcomes (68% of modified Rankin Scale score 0-2 vs. 27% for NIHSS score >6; P < 0.0001), lower mortality (14% vs. 48; P < 0.0001) and fewer parenchymal hematomas at day 1 (0% vs. 10%; P = 0.016). A multivariate analysis identified the following predictors for good outcome among patients with BAO with an NIHSS score <= 6: younger age, fewer passes, a cardioembolic cause, and the absence of need for angioplasty/stenting. CONCLUSIONS: Thrombectomy seems to be safer and more effective for mild BAO strokes with NIHSS score <= 6 than for more severe patients. Even although thrombectomy showed high rates of recanalization, a substantial proportion (32%) nevertheless had a poor long-term clinical outcome. The number of passes, patient's age, and stroke cause seem to be predictors of clinical outcome.

引用

页码：E400 / E414

页数：15

共 25 条

[1] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[2] Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke [J].

Bouslama, Mehdi ;

Haussen, Diogo C. ;

Aghaebrahim, Amin ;

Grossberg, Jonathan A. ;

Walker, Gregory ;

Rangaraju, Srikant ;

Horev, Anat ;

Frankel, Michael R. ;

Nogueira, Raul G. ;

Jovin, Tudor G. ;

Jadhav, Ashutosh P. .

STROKE, 2017, 48 (12) :3252-3257

[3] Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation A Multicenter Cohort Study [J].

Dargazanli, Cyril ;

Arquizan, Caroline ;

Gory, Benjamin ;

Consoli, Arturo ;

Labreuche, Julien ;

Redjem, Hocine ;

Eker, Omer ;

Decroix, Jean-Pierre ;

Corlobe, Astrid ;

Mourand, Isabelle ;

Gaillard, Nicolas ;

Ayrignac, Xavier ;

Charif, Mahmoud ;

Duhamel, Alain ;

Labeyrie, Paul-Emile ;

Riquelme, Carlos ;

Ciccio, Gabriele ;

Smajda, Stanislas ;

Desilles, Jean-Philippe ;

Gascou, Gregory ;

Lefevre, Pierre-Henri ;

Mantilla-Garcia, Daniel ;

Cagnazzo, Federico ;

Coskun, Oguzhan ;

Mazighi, Mikael ;

Riva, Roberto ;

Bourdain, Frederic ;

Labauge, Pierre ;

Rodesch, Georges ;

Obadia, Michael ;

Bonafe, Alain ;

Turjman, Francis ;

Costalat, Vincent ;

Piotin, Michel ;

Blanc, Raphael ;

Lapergue, Bertrand .

STROKE, 2017, 48 (12) :3274-3281

[4] Is Reperfusion Useful in Ischaemic Stroke Patients Presenting with a Low National Institutes of Health Stroke Scale and a Proximal Large Vessel Occlusion of the Anterior Circulation (vol 43, pg 305, 2017) [J].

Dargazanli, Cyril ;

Consoli, Arturo ;

Gory, Benjamin ;

Blanc, Raphael ;

Labreuche, Julien ;

Preda, Cristian ;

Bourdain, Frederic ;

Decroix, Jean-Pierre ;

Redjem, Hocine ;

Ciccio, Gabriele ;

Mazighi, Mikael ;

Smajda, Stanislas ;

Desilles, Jean-Philippe ;

Riva, Roberto ;

Labeyrie, Paul-Emile ;

Coskun, Oguzhan ;

Rodesch, Georges ;

Turjman, Francis ;

Piotin, Michel ;

Lapergue, Bertrand .

CEREBROVASCULAR DISEASES, 2017, 43 (5-6) :313-313

[5] First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial [J].

Ducroux, Celina ;

Piotin, Michel ;

Gory, Benjamin ;

Labreuche, Julien ;

Blanc, Raphael ;

Ben Maacha, Malek ;

Lapergue, Bertrand ;

Fahed, Robert .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2020, 12 (04) :386-391

[6] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

Roos, Yvo B. W. E. M. ;

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

[7] INTRA-ARTERIAL THROMBOLYTIC THERAPY IMPROVES OUTCOME IN PATIENTS WITH ACUTE VERTEBROBASILAR OCCLUSIVE DISEASE [J].

HACKE, W ;

ZEUMER, H ;

FERBERT, A ;

BRUCKMANN, H ;

DELZOPPO, GJ .

STROKE, 1988, 19 (10) :1216-1222

[8] Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis [J].

Haussen, Diogo C. ;

Bouslama, Mehdi ;

Grossberg, Jonathan A. ;

Anderson, Aaron ;

Belagage, Samir ;

Frankel, Michael ;

Bianchi, Nicolas ;

Rebello, Leticia C. ;

Nogueira, Raul G. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2017, 9 (10) :917-921

[9] Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients [J].

Heldner, Mirjam R. ;

Jung, Simon ;

Zubler, Christoph ;

Mordasini, Pasquale ;

Weck, Anja ;

Mono, Marie-Luise ;

Ozdoba, Christoph ;

El-Koussy, Marwan ;

Mattle, Heinrich P. ;

Schroth, Gerhard ;

Gralla, Jan ;

Arnold, Marcel ;

Fischer, Urs .

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2015, 86 (07) :755-760

[10] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

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