Endovascular Therapy for Acute Basilar Artery Occlusion: Comparison between Patients with and without Underlying Intracranial Atherosclerotic Stenosis

Gun Soo Kim; Seul Kee Kim; Byeong Hyeon Baek; Youn Young Lee; Woong Yoon

doi:10.3348/jksr.2017.76.4.287

Journal List > J Korean Soc Radiol > v.76(4) > 1087790

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Kim, Baek, Lee, and Yoon: Endovascular Therapy for Acute Basilar Artery Occlusion: Comparison between Patients with and without Underlying Intracranial Atherosclerotic Stenosis

Original Article

J Korean Soc Radiol 2017;76(4):287-293.

Published online: 7 January 2017

DOI: https://doi.org/10.3348/jksr.2017.76.4.287

Endovascular Therapy for Acute Basilar Artery Occlusion: Comparison between Patients with and without Underlying Intracranial Atherosclerotic Stenosis

Gun Soo Kim, Seul Kee Kim, Byeong Hyeon Baek, Youn Young Lee, Woong Yoon^∗,

Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea

^∗ Corresponding author: Woong Yoon, MD Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. Tel. 82-62-220-5746 Fax. 82-62-226-4380 E-mail: radyoon@jnu.ac.kr

Received 20 June 201619 July 2016 Accepted 23 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the characteristics and outcomes of multimodal endovascular therapy (EVT) in patients with acute basilar artery occlusion (BAO) with and without underlying intracranial atherosclerotic stenosis (ICAS).

Materials and Methods

We retrospectively analyzed the data from 50 patients with acute BAO who were treated with EVT. The baseline characteristics and outcomes of patients with and without ICAS were compared. Patients with ICAS underwent intracranial angioplasty or stenting after mechanical thrombectomy.

Results

Thirty percent of the patients (15/50) had underlying ICAS at the occlusion site. On pretreatment diffusion-weighted imaging (DWI), bilateral thalamic infarction was less frequently found in patients with ICAS (0% vs. 25.7%, p = 0.03). Occlusion in the proximal segment of the basilar artery was more common in patients with ICAS (60% vs. 5.7%, p < 0.001), whereas occlusion in the distal segment of the basilar artery was more common in patients without ICAS (26.7% vs. 91.4%, p < 0.001). There were no significant differences in the rates of successful revascularization, 3-month modified Rankin Scale scores of 0-2, symptomatic hemorrhage, and mortality between the two groups.

Conclusion

ICAS was common in patients with acute stroke due to BAO. The occlusion site and the presence or absence of bilateral thalamic infarction on pretreatment DWI might help predict the underlying ICAS in patients with acute BAO.

Index terms:

Index terms

Brain Infarction, Intracranial Arteriosclerosis, Basilar Artery, Mechanical Thrombolysis, Endovascular Procedures

REFERENCES

1. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011; 10:1002–1014.

2. Mortimer AM, Bradley M, Renowden SA. Endovascular therapy for acute basilar artery occlusion: a review of the literature. J Neurointerv Surg. 2012; 4:266–273.

3. Yeung JT, Matouk CC, Bulsara KR, Sheth KN. Endovascular revascularization for basilar artery occlusion. Interv Neurol. 2015; 3:31–40.

4. Baek JM, Yoon W, Kim SK, Jung MY, Park MS, Kim JT, et al. Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset. AJNR Am J Neuroradiol. 2014; 35:989–993.

5. Yoon W, Kim SK, Heo TW, Baek BH, Lee YY, Kang HK. Predic-tors of good outcome after stent-retriever thrombectomy in acute basilar artery occlusion. Stroke. 2015; 46:2972–2975.

6. Gory B, Eldesouky I, Sivan-Hoffmann R, Rabilloud M, Ong E, Riva R, et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and system-atic review. J Neurol Neurosurg Psychiatry. 2016; 87:520–525.

7. Bang OY. Intracranial atherosclerosis: current understand-ing and perspectives. J Stroke. 2014; 16:27–35.

8. Yoon W, Kim SK, Park MS, Kim BC, Kang HK. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery. 2015; 76:680–686. discussion 686.

9. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol. 2000; 21:643–646.

10. Archer CR, Horenstein S. Basilar artery occlusion: clinical and radiological correlation. Stroke. 1977; 8:383–390.

11. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013; 44:2650–2663.

12. Tei H, Uchiyama S, Usui T, Ohara K. Posterior circulation AS-PECTS on diffusion-weighted MRI can be a powerful mark-er for predicting functional outcome. J Neurol. 2010; 257:767–773.

13. Song YM. Topographic patterns of thalamic infarcts in as-sociation with stroke syndromes and aetiologies. J Neurol Neurosurg Psychiatry. 2011; 82:1083–1086.

14. Kang DH, Kim YW, Hwang YH, Park SP, Kim YS, Baik SK. Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose in-tra-arterial tirofiban. Cerebrovasc Dis. 2014; 37:350–355.

15. Lee JS, Hong JM, Lee KS, Suh HI, Choi JW, Kim SY. Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease. J Stroke. 2016; 18:96–101.

16. Gao F, Lo WT, Sun X, Mo DP, Ma N, Miao ZR. Combined use of mechanical thrombectomy with angioplasty and stenting for acute basilar occlusions with underlying severe intracranial vertebrobasilar stenosis: preliminary experience from a single chinese center. AJNR Am J Neuroradiol. 2015; 36:1947–1952.

17. Kim SK, Yoon W, Moon SM, Park MS, Jeong GW, Kang HK. Outcomes of manual aspiration thrombectomy for acute ischemic stroke refractory to stent-based thrombectomy. J Neurointerv Surg. 2015; 7:473–477.

18. Lee SH, Lee BH, Hwang YJ, Kim SY, Lee JY, Hong KS, et al. Mechanical thrombectomy using a solitaire stent in acute ischemic stroke: the relationship between the visible ante-grade flow on first device deployment and final success in revascularization. J Korean Soc Radiol. 2015; 72:313–318.

19. Lazzaro NA, Wright B, Castillo M, Fischbein NJ, Glastonbury CM, Hildenbrand PG, et al. Artery of percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol. 2010; 31:1283–1289.

20. Li X, Agarwal N, Hansberry DR, Prestigiacomo CJ, Gandhi CD. Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature. J Neurointerv Surg. 2015; 7:95–98.

Fig. 1.

A 74-year-old patient with acute stroke due to acute basilar artery occlusion. A. DWI images show a high signal intensity lesion involving the right sided pons. There is no evidence of acute infarction in bilateral thalami. B. Left vertebral artery angiography shows an occlusion (arrow) in the proximal segment of the basilar artery. C. Angiography obtained after single passage of the stent-retriever reveals a severe underlying atherosclerotic stenosis (arrow) at the previous occlusion site. D. Left vertebral angiography obtained after intracranial angioplasty and stenting shows complete recanalization of the basilar artery with good distal perfusion. Arrows indicate the proximal and distal ends of the Wingspan stent. E. Photograph shows small fragmented thrombi retrieved with a Solitaire stent. F. Maximum-intensity-projection image of the followup CT angiography 1 week after the procedure shows good patency of the stented segment (arrows) of the basilar artery. DWI = diffusion-weighted imaging

Table 1.

Baseline Characteristics of Study Population

Characteristics	All Patients (n = 50)	Patients with ICAS (n = 15)	Patients without ICAS (n = 35)	p-Value
Age, years	69.3 ± 12.45	67.2 ± 10.15	70.1 ± 13.35	0.294
Male sex, n (%)	26 (52.0)	11 (73.3)	15 (42.9)	0.48
Risk factor, n (%)
Hypertension	31 (62.0)	11 (73.3)	20 (57.1)	0.28
Diabetes mellitus	13 (26.0)	6 (40)	7 (20)	0.14
Dyslipidemia	12 (24.0)	5 (33.3)	7 (20)	0.31
Smoking	13 (26.0)	5 (33.3)	8 (22.9)	0.43
History of previous CAD	3 (6.0)	0 (0)	3 (8.6)	0.24
Occlusion sites, n (%)
Proximal	11 (22.0)	9 (60.0)	2 (5.7)	< 0.001
Middle	3 (6.0)	2 (13.3)	1 (2.9)	0.15
Distal	36 (72.0)	4 (26.7)	32 (91.4)	< 0.001
Bilateral thalamic infarction, n (%)	9 (18.0)	0 (0)	9 (25.7)	0.03
Intravenous thrombolysis, n (%)	14 (28.0)	7 (46.7)	7 (20.0)	0.054
Time to procedure, min	282.8 ± 126.26	321.0 ± 168.32	266.4 ± 101.92	0.439
Procedure time, min	33.8 ± 18.13	40.9 ± 19.70	30.7 ± 16.79	0.028
Time to revascularization, min	319.3 ± 128.39	361.9 ± 171.67	301.1 ± 102.36	0.391
Baseline NIHSS score	11.9 ± 6.04	11.9 ± 5.59	11.9 ± 6.30	0.916
pc-ASPECTS	6.9 ± 1.53	7.0 ± 1.13	6.9 ± 1.68	0.948

CAD = coronary artery disease, ICAS = Intracranial atherosclerotic stenosis, NIHSS = National Institutes of Health Stroke Scale, pc-ASPECTS = Posterior circulation Acute Stroke Prognosis Early CT Score

Table 2.

Outcomes after Endovascular Therapy in 50 Patients with Acute Stroke due to Basilar Artery Occlusion

Characteristics	All Patients (n = 50)	Patients with ICAS (n = 15)	Patients without ICAS (n = 35)	p-Value
m-TICI 2b or 3, n (%)	48 (96.0)	15 (100.0)	33 (94.3)	0.345
mRS 0–2, n (%)	27 (54.0)	8 (53.3)	19 (54.3)	0.951
Symptomatic hemorrhage, n (%)	0 (0)	0 (0)	0 (0)	NS
Mortality, n (%)	6 (12.0)	2 (13.3)	4 (11.4)	0.849

ICAS = Intracranial atherosclerotic stenosis, mRS = modified Rankin Scale, m-TICI = modified Thrombolysis in Cerebral Infarction, NS = non-significant

TOOLS

Similar articles