• Johannes C Gerber, Dirk Daubner, Daniel Kaiser, Kay Engellandt, Kevin Haedrich, Angela Mueller, Volker Puetz, Jennifer Linn, and Andrij Abramyuk.
• Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany. johannes.gerber@uniklinikum-dresden.de.
• Neuroradiology. 2017 Mar 1; 59 (3): 297-304.

IntroductionThe study aimed to compare efficacy and safety of aspiration thrombectomy (AT) to stentriever thrombectomy (SRT) in patients with basilar artery (BA) occlusion (BAO).MethodsWe retrospectively included patients with the following characteristics: acute BAO or occlusion of the intracranial vertebral artery (ICVA) and endovascular therapy (EVT) with stentriever (SRT) or aspiration thrombectomy (AT). Additional extra- but not intracranial EVT and intravenous thrombolysis (IVT) were allowed.ResultsBetween January 2013 and April 2016, 33 patients fulfilled the criteria (13 treated with SRT, 20 with AT). Prior to EVT, 23 (70%) patients received IVT. The proximal intracranial occlusion was ICVA in 2 patients, proximal BA in 5 patients, middle BA in 20 patients, and distal BA in 6 patients. Mean time to treatment was 334 min (95% CI 276-391 min). Procedure duration differed significantly (p = 0.002) as follows: 97 min with SRT (95% CI 69-124 min) and 55 min with AT (95% CI 43-66 min). Recanalization (arterial occlusive lesion (AOL) 2/3) was achieved in 26 patients (79%). Complete recanalization (AOL 3) happened more often with AT (75% (95% CI 65-85%)) compared to SRT (46% (95% CI 32-60%)). Conversion rate 6% (two patients). Hemorrhages occurred in 12 (36%) patients, periprocedural complications in eight (three dissections, five embolizations to new territory) (no group difference). Ten patients (30%) had a favorable outcome (mRS ≤3) at discharge; mortality rate was 24% (eight deaths) (no group difference).ConclusionIn primarily embolic BAO, aspiration thrombectomy was faster, effective and not detrimental to outcome as compared to stentriever thrombectomy. Thus, it may be justified to use aspiration thrombectomy as first-line treatment in these patients.

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