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Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results?
Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9866638/ https://www.ncbi.nlm.nih.gov/pubmed/36676720 http://dx.doi.org/10.3390/medicina59010096 |
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author | Ekkert, Aleksandra Jokimaitytė, Une Tutukova, Valerija Lengvenis, Givi Masiliūnas, Rytis Jatužis, Dalius |
author_facet | Ekkert, Aleksandra Jokimaitytė, Une Tutukova, Valerija Lengvenis, Givi Masiliūnas, Rytis Jatužis, Dalius |
author_sort | Ekkert, Aleksandra |
collection | PubMed |
description | Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with EVT or bridging therapy (BT) in anterior circulation stroke (ACS) versus PCS (middle cerebral artery occlusion (MCAO) and basilar artery occlusion (BAO), and establish the risk factors for poor outcome. Materials and Methods: we analyzed the data of 279 subjects treated with EVT due to LVO-caused stroke in a comprehensive stroke centre in 2015–2021. The primary outcome was hospital mortality, secondary outcomes were National Institutes of Health Stroke Scale (NIHSS) after 24 h, early neurological deterioration, futile recanalization (FR), the ambulatory outcome at discharge, and complications. Results: BAO presented with higher baseline NIHSS scores (19 vs. 14, p < 0.001), and longer door-to-puncture time (93 vs. 82 min, p = 0.034), compared to MCAO. Hospital mortality and the percentage of FR were the same in BAO and almost two times higher than in MCAO (20.0% vs. 10.3%, p = 0.048), other outcomes did not differ. In BAO, unsuccessful recanalization was the only significant predictor of the lethal outcome, though there were trends for PAD and RF predicting lethal outcome. A trend for higher risk of symptomatic intracranial hemorrhage (sICH) was observed in the BAO group when BT was applied. Nevertheless, neither BT nor sICH predicted lethal outcomes in the BAO group. Conclusions: Compared to the modern gold standard of EVT in the ACS, early outcomes in BAO remain poor, there is a substantial amount of FR. Nevertheless, unsuccessful recanalization remains the strongest predictor of lethal outcomes. BT in PCS might pose a higher risk for sICH, but not the lethal outcome, although this finding requires further investigation in larger trials. |
format | Online Article Text |
id | pubmed-9866638 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-98666382023-01-22 Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? Ekkert, Aleksandra Jokimaitytė, Une Tutukova, Valerija Lengvenis, Givi Masiliūnas, Rytis Jatužis, Dalius Medicina (Kaunas) Article Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with EVT or bridging therapy (BT) in anterior circulation stroke (ACS) versus PCS (middle cerebral artery occlusion (MCAO) and basilar artery occlusion (BAO), and establish the risk factors for poor outcome. Materials and Methods: we analyzed the data of 279 subjects treated with EVT due to LVO-caused stroke in a comprehensive stroke centre in 2015–2021. The primary outcome was hospital mortality, secondary outcomes were National Institutes of Health Stroke Scale (NIHSS) after 24 h, early neurological deterioration, futile recanalization (FR), the ambulatory outcome at discharge, and complications. Results: BAO presented with higher baseline NIHSS scores (19 vs. 14, p < 0.001), and longer door-to-puncture time (93 vs. 82 min, p = 0.034), compared to MCAO. Hospital mortality and the percentage of FR were the same in BAO and almost two times higher than in MCAO (20.0% vs. 10.3%, p = 0.048), other outcomes did not differ. In BAO, unsuccessful recanalization was the only significant predictor of the lethal outcome, though there were trends for PAD and RF predicting lethal outcome. A trend for higher risk of symptomatic intracranial hemorrhage (sICH) was observed in the BAO group when BT was applied. Nevertheless, neither BT nor sICH predicted lethal outcomes in the BAO group. Conclusions: Compared to the modern gold standard of EVT in the ACS, early outcomes in BAO remain poor, there is a substantial amount of FR. Nevertheless, unsuccessful recanalization remains the strongest predictor of lethal outcomes. BT in PCS might pose a higher risk for sICH, but not the lethal outcome, although this finding requires further investigation in larger trials. MDPI 2022-12-31 /pmc/articles/PMC9866638/ /pubmed/36676720 http://dx.doi.org/10.3390/medicina59010096 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Ekkert, Aleksandra Jokimaitytė, Une Tutukova, Valerija Lengvenis, Givi Masiliūnas, Rytis Jatužis, Dalius Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? |
title | Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? |
title_full | Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? |
title_fullStr | Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? |
title_full_unstemmed | Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? |
title_short | Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results? |
title_sort | endovascular treatment of basilar artery occlusion: what can we learn from the results? |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9866638/ https://www.ncbi.nlm.nih.gov/pubmed/36676720 http://dx.doi.org/10.3390/medicina59010096 |
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