Endovascular mechanical thrombectomy with the Solitaire device for the treatment of acute basilar artery occlusion

• Published in: World neurosurgery 2016-05, Vol.89, p.301-308
• Main Authors: Huo, Xiaochuan, Ph.D, Gao, Feng, Ph.D, Sun, Xuan, Ph.D, Ma, Ning, Ph.D, Song, Ligang, Ph.D, Mo, Dapeng, Ph.D, Liu, Lian, Ph.D, Wang, Bo, Ph.D, Zhang, Xuelei, MD, Miao, Zhongrong, Ph.D
• Format: Article
• Language: English
• Subjects: Acute basilar artery occlusion; Acute Disease; Arterial Occlusive Diseases - mortality; Arterial Occlusive Diseases - surgery; Basilar Artery - surgery; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Female; Follow-Up Studies; Humans; Male; Mechanical thrombectomy; Middle Aged; Neurosurgery; Plaque, Atherosclerotic - mortality; Plaque, Atherosclerotic - surgery; Prospective Studies; Severity of Illness Index; Solitaire device; Thrombectomy - instrumentation; Thrombectomy - methods; Treatment Outcome; Vertebrobasilar Insufficiency - mortality; Vertebrobasilar Insufficiency - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.02.017

Abstract Objective To determine the safety and efficacy of endovascular treatment with the Solitaire device for acute basilar artery occlusion (ABAO) and identify factors affecting clinical outcomes. Methods We enrolled 36 consecutive ABAO patients (aged 58.6 ± 8.10 years) who underwent mechanical thrombectomy with the Solitaire device. We analyzed baseline characteristics, mechanical thrombectomy results, and factors predicting clinical outcomes, which were assessed at 90 days. Results The median pre-thrombectomy National Institutes of Health Stroke Scale (NIHSS) score was 25.50 (interquartile range: 21.00–29.00); the median pre-thrombectomy Glasgow coma scale (GCS) score was 8.00 (5.00–9.75). Thirty patients (83.3%) had atherosclerotic stenosis of the occluded artery, and 25 underwent angioplasty (69.4%). Recanalization was successful (Thrombolysis in Cerebral Infarction grade: 2b–3) in 34 patients (94.4%). Six symptomatic intracranial hemorrhages (16.67%) occurred. Favorable outcomes (modified Rankin scale [mRS] score: 0–2) were achieved in 27.8% patients (10/36). The overall mortality rate was 30.6% (11/36) at 90 days. On univariate analysis, low pre-thrombectomy GCS and high post-thrombectomy NIHSS scores were associated with poor outcomes (mRS score >2) and mortality. Pre-thrombectomy unconsciousness, onset-to-recanalization time > 10.5 h, and severe stenosis were associated with poor outcomes. Age ≥ 60 years was associated with mortality. Conclusions Endovascular treatment with the Solitaire device yielded high recanalization rates in ABAO patients and favorable clinical outcomes in approximately one-third of patients. Intracranial stenosis was the main cause of occlusion. Angioplasty was commonly performed during mechanical thrombectomy to improve recanalization and prognosis. Early recanalization and better pre-thrombectomy status predicted better outcomes.