• María Alonso de Leciñana, Michal M Kawiorski, Álvaro Ximénez-Carrillo, Antonio Cruz-Culebras, Andrés García-Pastor, Patricia Martínez-Sánchez, Andrés Fernández-Prieto, José Luis Caniego, Jose Carlos Méndez, Gustavo Zapata-Wainberg, Alicia De Felipe-Mimbrera, Fernando Díaz-Otero, Gerardo Ruiz-Ares, Remedios Frutos, Eduardo Bárcena-Ruiz, Eduardo Fandiño, Begoña Marín, José Vivancos, Jaime Masjuan, Antonio Gil-Nuñez, Exuperio Díez-Tejedor, Blanca Fuentes, and Madrid Stroke Network.
• La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
• J Neurointerv Surg. 2017 Dec 1; 9 (12): 1173-1178.

Background And PurposeThe benefits of mechanical thrombectomy (MT) in basilar artery occlusions (BAO) have not been explored in recent clinical trials. We compared outcomes and procedural complications of MT in BAO with anterior circulation occlusions.MethodsData from the Madrid Stroke Network multicenter prospective registry were analyzed, including baseline characteristics, procedure times, procedural complications, symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS), and mortality at 3 months.ResultsOf 479 patients treated with MT, 52 (11%) had BAO. The onset to reperfusion time lapse was longer in patients with BAO (median (IQR) 385 min (320-540) vs 315 min (240-415), p<0.001), as was the duration of the procedures (100 min (40-130) vs 60 min (39-90), p=0.006). Moreover, the recanalization rate was lower (75% vs 84%, p=0.01). A trend toward more procedural complications was observed in patients with BAO (32% vs 21%, p=0.075). The frequency of SICH was 2% vs 5% (p=0.25). At 3 months, patients with BAO had a lower rate of independence (mRS 0-2) (40% vs 58%, p=0.016) and higher mortality (33% vs 12%, p<0.001). The rate of futile recanalization was 50% in BAO versus 35% in anterior circulation occlusions (p=0.05). Age and duration of the procedure were significant predictors of futile recanalization in BAO.ConclusionsMT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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