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Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion—a retrospective single center experience

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The study aimed to compare efficacy and safety of aspiration thrombectomy (AT) to stentriever thrombectomy (SRT) in patients with basilar artery (BA) occlusion (BAO).

Methods

We 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.

Results

Between 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).

Conclusion

In 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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Authors and Affiliations

  1. Neuroradiology, University Hospital Carl Gustav Carus, Fetscherstraße 74, D-01304, Dresden, Germany

    Johannes C. Gerber, Dirk Daubner, Daniel Kaiser, Kay Engellandt, Kevin Haedrich, Angela Mueller, Jennifer Linn & Andrij Abramyuk

  2. Neurology, University Hospital Carl Gustav Carus, Dresden, Germany

    Volker Puetz

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  1. Johannes C. Gerber
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  2. Dirk Daubner
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  3. Daniel Kaiser
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Correspondence to Johannes C. Gerber.

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Funding

No funding was received for this study.

Conflict of interest

JCG has speaking engagements with Penumbra Inc.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Gerber, J.C., Daubner, D., Kaiser, D. et al. Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion—a retrospective single center experience. Neuroradiology 59, 297–304 (2017). https://doi.org/10.1007/s00234-017-1802-6

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