Skip to main content
SpringerLink
Log in

Endovascular Treatment for Acute Basilar Artery Occlusion: A Comparison of Arteriosclerotic, Embolic and Tandem Lesions

  • Clinical Investigation
  • Stroke/Neurointerventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the safety and efficacy of endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to intracranial atherosclerosis-related basilar artery occlusion (ICAS-related BAO) by comparison with embolic and tandem occlusion.

Methods

We retrospectively reviewed consecutive patients with AIS due to BAO who underwent EVT. Patients were assigned to the ICAS-related group and embolic group, and tandem group based on the etiology. Baseline data, procedural details, and clinical outcomes were compared between the three groups.

Results

A total of 100 patients (ICAS-related group: 31; embolic group: 41; tandem group: 28) were included. No significant difference was observed in the successful reperfusion (mTICI 2b or 3), but the procedural time differed significantly (60 min vs. 43 min vs. 60 min, P = 0.010). There were no differences in the different intracranial hemorrhage grades among the three groups (P = 0.134). After adjusting for baseline differences, there was no significant difference in pairwise comparisons regarding favorable outcome (mRS 0–2), moderate outcome (mRS 0–3), and mortality.

Conclusions

Endovascular treatment for patients with acute ICAS-related BAO had equal efficacy and safety compared with embolic BAO and tandem BAO. Primary endovascular treatment and rescue modalities were effective treatments for acute ICAS-related BAO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

EVT:

Endovascular treatment

ICAS:

Intracranial atherosclerosis

BAO:

Basilar artery occlusion

BATMAN:

The Basilar Artery on Computed Tomography Angiography

mTICI:

Modified Thrombolysis in Cerebral Infarction

mRS:

Modified Rankin Scale

ICH:

Intracranial hemorrhage

NIHSS:

National Institute of Health Stroke Scale

LVO:

Large vessel occlusion

References

  1. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10(11):1002–14. https://doi.org/10.1016/S1474-4422(11)70229-0.

    Article  PubMed  Google Scholar 

  2. Liu X, Dai Q, Ye R, Zi W, Liu Y, Wang H, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol. 2020;19(2):115–22. https://doi.org/10.1016/S1474-4422(19)30395-3.

    Article  PubMed  Google Scholar 

  3. Writing Group for the BG, Zi W, Qiu Z, Wu D, Li F, Liu H, et al. Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurol. 2020;77(5):561–73. https://doi.org/10.1001/jamaneurol.2020.0156.

    Article  Google Scholar 

  4. Langezaal LCM, van der Hoeven E, Mont’Alverne FJA, de Carvalho JJF, Lima FO, Dippel DWJ, et al. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med. 2021;384(20):1910–20. https://doi.org/10.1056/NEJMoa2030297.

    Article  PubMed  Google Scholar 

  5. Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: a review. Stroke. 1986;17(4):648–55. https://doi.org/10.1161/01.str.17.4.648.

    Article  CAS  PubMed  Google Scholar 

  6. Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, et al. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990;40(10):1541–5. https://doi.org/10.1212/wnl.40.10.1540.

    Article  CAS  PubMed  Google Scholar 

  7. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70. https://doi.org/10.1161/01.str.20.7.864.

    Article  CAS  PubMed  Google Scholar 

  8. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–7. https://doi.org/10.1161/01.str.19.5.604.

    Article  PubMed  Google Scholar 

  9. Alemseged F, Shah DG, Diomedi M, Sallustio F, Bivard A, Sharma G, et al. The basilar artery on computed tomography angiography prognostic score for basilar artery occlusion. Stroke. 2017;48(3):631–7. https://doi.org/10.1161/STROKEAHA.116.015492.

    Article  PubMed  Google Scholar 

  10. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2013;44(3):870–947. https://doi.org/10.1161/STR.0b013e318284056a.

    Article  PubMed  Google Scholar 

  11. Yang W, Zhang Y, Li Z, Zhang L, Li H, Hua W, et al. Differences in safety and efficacy of endovascular treatment for acute ischemic stroke: a propensity score analysis of intracranial atherosclerosis-related occlusion versus embolism. Clin Neuroradiol. 2020. https://doi.org/10.1007/s00062-020-00899-x.

    Article  PubMed  Google Scholar 

  12. 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(9):2650–63. https://doi.org/10.1161/STROKEAHA.113.001972.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) Second European-Australasian acute stroke study investigators. Lancet. 1998;352(9136):1245–51. https://doi.org/10.1016/s0140-6736(98)08020-9.

    Article  CAS  PubMed  Google Scholar 

  14. Singer OC, Berkefeld J, Nolte CH, Bohner G, Haring HP, Trenkler J, et al. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol. 2015;77(3):415–24. https://doi.org/10.1002/ana.24336.

    Article  PubMed  Google Scholar 

  15. Kim YW, Hong JM, Park DG, Choi JW, Kang DH, Kim YS, et al. Effect of intracranial atherosclerotic disease on endovascular treatment for patients with acute vertebrobasilar occlusion. AJNR Am J Neuroradiol. 2016;37(11):2072–8. https://doi.org/10.3174/ajnr.A4844.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lee YY, Yoon W, Kim SK, Baek BH, Kim GS, Kim JT, et al. Acute basilar artery occlusion: differences in characteristics and outcomes after endovascular therapy between patients with and without underlying severe atherosclerotic stenosis. AJNR Am J Neuroradiol. 2017;38(8):1600–4. https://doi.org/10.3174/ajnr.A5233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Baek JH, Kim BM, Heo JH, Kim DJ, Nam HS, Kim YD. Endovascular and clinical outcomes of vertebrobasilar intracranial atherosclerosis-related large vessel occlusion. Front Neurol. 2019;10:215. https://doi.org/10.3389/fneur.2019.00215.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Baik SH, Park HJ, Kim JH, Jang CK, Kim BM, Kim DJ. Mechanical thrombectomy in subtypes of basilar artery occlusion: relationship to recanalization rate and clinical outcome. Radiology. 2019;291(3):730–7. https://doi.org/10.1148/radiol.2019181924.

    Article  PubMed  Google Scholar 

  19. Fan Y, Li Y, Zhang T, Li X, Yang J, Wang B, et al. Endovascular therapy for acute vertebrobasilar occlusion underlying atherosclerosis: a single institution experience. Clin Neurol Neurosurg. 2019;176:78–82. https://doi.org/10.1016/j.clineuro.2018.11.016.

    Article  PubMed  Google Scholar 

  20. Zhang X, Luo G, Jia B, Mo D, Ma N, Gao F, et al. Differences in characteristics and outcomes after endovascular therapy: a single-center analysis of patients with vertebrobasilar occlusion due to underlying intracranial atherosclerosis disease and embolism. Interv Neuroradiol. 2019;25(3):254–60. https://doi.org/10.1177/1591019918811800.

    Article  PubMed  Google Scholar 

  21. Miao Z, Zhang Y, Shuai J, Jiang C, Zhu Q, Chen K, et al. Thirty-day outcome of a multicenter registry study of stenting for symptomatic intracranial artery stenosis in China. Stroke. 2015;46(10):2822–9. https://doi.org/10.1161/STROKEAHA.115.010549.

    Article  PubMed  Google Scholar 

  22. Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the aster randomized clinical trial. JAMA. 2017;318(5):443–52. https://doi.org/10.1001/jama.2017.9644.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Turk ASR, Siddiqui A, Fifi JT, De Leacy RA, Fiorella DJ, Gu E, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet. 2019;393(10175):998–1008. https://doi.org/10.1016/S0140-6736(19)30297-1.

    Article  PubMed  Google Scholar 

  24. Baek JH, Kim BM. Angiographical identification of intracranial, atherosclerosis-related, large vessel occlusion in endovascular treatment. Front Neurol. 2019;10:298. https://doi.org/10.3389/fneur.2019.00298.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kang DH, Yoon W, Baek BH, Kim SK, Lee YY, Kim JT, et al. Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration. J Neurosurg. 2019;132(4):1202–8. https://doi.org/10.3171/2019.1.JNS182905.

    Article  PubMed  Google Scholar 

  26. Kang DH, Yoon W, Kim SK, Baek BH, Lee YY, Kim YW, et al. Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis. J Neurosurg. 2018. https://doi.org/10.3171/2018.1.JNS172350.

    Article  PubMed  Google Scholar 

  27. Yan Z, Shi Z, Wang Y, Zhang C, Cao J, Ding C, et al. Efficacy and safety of low-dose tirofiban for acute intracranial atherosclerotic stenosis related occlusion with residual stenosis after endovascular treatment. J Stroke Cerebrovasc Dis. 2020;29(4): 104619. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104619.

    Article  PubMed  Google Scholar 

  28. Yang D, Lin M, Wang S, Wang H, Hao Y, Zi W, et al. Primary angioplasty and stenting may be superior to thrombectomy for acute atherosclerotic large-artery occlusion. Interv Neuroradiol. 2018;24(4):412–20. https://doi.org/10.1177/1591019918763380.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zhao W, Che R, Shang S, Wu C, Li C, Wu L, et al. Low-dose tirofiban improves functional outcome in acute ischemic stroke patients treated with endovascular thrombectomy. Stroke. 2017;48(12):3289–94. https://doi.org/10.1161/STROKEAHA.117.019193.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors state that this work has received funding from Intelligent Medical Special Research Project (No. 2018ZHYL0218); Specialty Feature Construction Project of Pudong Health and Family Planning Commission of Shanghai (No. PWZzb2017-09); Scientific research program of Shanghai Science and Technology Commission (No.18ZR1438500)

Funding

This study was funded by Intelligent Medical Special Research Project (No. 2018ZHYL0218); Specialty Feature Construction Project of Pudong Health and Family Planning Commission of Shanghai (No. PWZzb2017-09); Scientific research program of Shanghai Science and Technology Commission (No.18ZR1438500).

This study sponsors were not involved in the study design, study conduct, article preparation or review.

Author information

Author notes

  1. Wenjin Yang

    Present address: Department of Neurosurgery, Pudong New Area People’s Hospital, 490 Chuanhuan South Road, Shanghai, 201299, China

  2. Wenjin Yang and Lei Zhang have contributed equally to this work.

Authors and Affiliations

  1. Cerebrovascular Disease Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

    Wenjin Yang, Lei Zhang, Zifu Li, Yongxin Zhang, He Li, Weilong Hua, Jianan Li, Hongjian Zhang, Hongjian Shen, Pengfei Xing, Yongwei Zhang, Bo Hong, Jianmin Liu & Pengfei Yang

Authors
  1. Wenjin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zifu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yongxin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. He Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weilong Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hongjian Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hongjian Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pengfei Xing
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yongwei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jianmin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Pengfei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Wenjin Yang: Data collection, paper drafting, and data statistics. Lei Zhang: Data collection, paper modify, and data statistics. Zifu Li: The surgical treatment. Yongxin Zhang: The surgical treatment. He Li: The postoperative management. Weilong Hua: The postoperative management. Jianan Li: Data record. Hongjian Zhang: Follow-up management. Hongjian Shen: Follow-up management. Pengfei Xing: Data record. Yongwei Zhang: The assessment of vessel occlusion. Bo Hong: The assessment of vessel occlusion. Jianmin Liu: Supervision, the consensus for etiology of vessel occlusion. Pengfei Yang: Study design, project administration, and funding acquisition.

Corresponding author

Correspondence to Pengfei Yang.

Ethics declarations

Conflict of interest

The authors declare that they have no financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Informed Consent

Informed consent was not required because of the retrospective design in this study.

Ethical Approval

Ethics approval was obtained from the local institutional review board.

Human or Animal participants

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

Consent for Publication

Consent for publication was not required for every individual person’s data included in the study because of the anonymization of all data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, W., Zhang, L., Li, Z. et al. Endovascular Treatment for Acute Basilar Artery Occlusion: A Comparison of Arteriosclerotic, Embolic and Tandem Lesions. Cardiovasc Intervent Radiol 44, 1954–1963 (2021). https://doi.org/10.1007/s00270-021-02994-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-021-02994-z

Keywords

Search

Navigation