Mechanical Thrombectomy With The Solitaire Device In Acute Basilar Artery Occlusion

Background and purpose Basilar artery occlusion remains one of the most devastating subtypes of ischemic stroke.The prognosis is poor if early recanalization is not achieved.If the time from onset to admission is within 4.5 hours,Intravenous thrombolytic therapy is an effective treatment for acute ischaemic stroke.However,Intravenous thrombolytic therapy was limited in clinical practice primarily because of the narrow time window and recanalization rate.So,The purpose of this study was to evaluate the safety and efficacy of mechanical thrombectomy with the Solitaire device for the treatment of acute basilar artery occlusion(ABAO)and.secondarily to identify prognostic factors.Methods The clinical and radiological data of fourteen patients with angiographically proven acute BAO treated by mechanical thrombectomy with the Solitaire stent device in the department of Neurosurgery,Dalian Municipal Central Hospital and General Hospital of Shenyang Military from June 2015 and December 2016 were analyzed retrospectively.All patients were treated within 24 hours after symptom onset.Recanalization was assessed using the modified Thrombolysis in Cerebral Infarction(TICI)scale system and successful recanalisation was defined as mTICI 2b-3.A good clinical outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months.Additionally,the relation between the circulation collateral score based on Digital Subtraction Angiography,initial NIHSS,time from admission to groin puncture,the mean number of passes required to achieve recanalisation and clinical outcome was analyzed by one-way ANOVA test.Information about endovascular treatment-related complications were recorded as procedure information,including symptomatic intracranial hemorrhage,distal embolization,vessel perforation,arterial dissection and vasospasm.Results The mean age of the patients was(66.5±6.3)years and 10 patients were men.The median time from onset to admission was 6.0(IQR 5.0-8.3)hours.According to the circulation collateral score based on Digital Subtraction Angiography,3 patients was grade 0,3patients was grade 2,1 patient was grade 1.The median time from admission to groin puncture was 119.5(IQR 108.8-130.3)minutes.The median National Institutes of Health stroke scale after treatment was significantly lower than at admission(20.0(IQR 18.3-22.8)vs.8.5(IQR 3.5-12.8);P=0.002).The median procedure time from groin puncture to recanalization(mTICI?2b)was 58.0(IQR 50.0-77.0)minutes.the mean number of passes required to achieve recanalisation was 2(IQR 1-3)times.2 patients received IV thrombolysis prior toMT,3 patients was in combination with balloon dilatation,1 patient was in combination with Solitaire stent release.4 patients received IA thrombolysis prior toMT.Successful recanalisation(modified treatment in cerebral ischaemia scale 2b-3)was achieved in 13 patients(93%).The event of symptomatic intracranial hemorrhage were observed in one patients.Vasospasm occurred in 2 patients during operation,and no other device-related complications occurred.At 90-day follow-up,good clinical outcome was achieved in 4 of 14 patients(28.6%),while 2 patients died(14.3%).In the one-way ANOVA test,the circulation collateral score based on Digital Subtraction Angiography was significantly associated with clinical outcome.And high circulation collateral score often indicates a good clinical outcome.There was no significant correlation between initial NIHSS,time from admission to groin puncture,the mean number of passes required to achieve recanalisation and clinical outcome.Conclusion In ABAO,Mechanical thrombectomy with Solitaire device was an effective and safe therapy,which achieved a high rate of angiographic recanalization and improved functional outcome.The circulation collateral score based on Digital Subtraction Angiography is an important predictor of clinical outcome.