Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Switzerland.
AJNR Am J Neuroradiol. 2013 Jan;34(1):159-63. doi: 10.3174/ajnr.A3168. Epub 2012 Jun 21.
Acute BAO is a devastating neurological condition associated with a poor clinical outcome and a high mortality rate. Recanalization has been identified as a major prognostic factor for good outcome in BAO. Mechanical thrombectomy using retrievable stents is an emerging treatment option for acute stroke. First clinical trials using stent retrievers have shown promising high recanalization rates. However, these studies mainly included large artery occlusions in the anterior circulation with only a few or single cases of BAO. Therefore, the purpose of this study was to evaluate technical feasibility, safety, and efficacy of mechanical thrombectomy using retrievable stent in the treatment of acute BAO.
Fourteen consecutive patients with BAO undergoing endovascular therapy using retrievable stents (Solitaire FR Revascularization Device) were included. Additional multimodal treatment approaches included thromboaspiration, intravenous and/or intra-arterial thrombolysis, and PTA/ permanent stent placement. Recanalization rates after multimodal therapy and stent retrieval were determined. Clinical outcome and mortality were assessed 3 months after treatment.
Median patient age was 64.5 years (range 55-85). Median NIHSS score at presentation was 21 (range 5-36). Overall, successful recanalization (TICI 3 or 2b) was achieved in all patients (TICI 3 in 78.6%, 11/14). In 4 patients (28.6%), insufficient recanalization after stent retrieval was due to an underlying atherosclerotic stenosis. Additional deployment of a permanent intracranial stent was performed in 3 patients (21.4%) and PTA alone in 1 patient (7.1%), resulting in final TICI 3 in 1 patient and TICI 2b in 3 patients. Stent retrieval alone was performed in 4 patients (28.6%). Average number of device passes was 1.3 (range 1-3). Median procedure time to maximal recanalization was 47 minutes (range 10-252). No device-related complications or thromboembolic occlusion of a previously unaffected artery occurred. There was no symptomatic intracranial hemorrhage. At 3 months, good functional outcome (mRS 0-2) was observed in 28.6% (4/14); overall mortality was 35.7% (5/14).
A multimodal endovascular approach using retrievable stents in BAO has high recanalization rates, with very low complication rates. Underlying atherothrombotic stenotic lesions of the basilar artery may still necessitate additional permanent stent placement to achieve complete recanalization.
急性基底动脉闭塞（BAO）是一种毁灭性的神经系统疾病，与不良临床预后和高死亡率相关。再通已被确定为 BAO 预后良好的主要预测因素。使用可回收支架的机械血栓切除术是急性卒中介入治疗的新兴选择。使用支架取栓器的首次临床试验显示出有希望的高再通率。然而，这些研究主要包括前循环中的大动脉闭塞，只有少数或单个 BAO 病例。因此，本研究的目的是评估使用可回收支架治疗急性 BAO 的技术可行性、安全性和疗效。
14 例 BAO 患者接受可回收支架（Solitaire FR 血管再通装置）血管内治疗。额外的多模态治疗方法包括血栓抽吸、静脉内和/或动脉内溶栓以及 PTA/永久支架置入。采用多模态治疗和支架取出后确定再通率。治疗 3 个月后评估临床结局和死亡率。
中位患者年龄为 64.5 岁（55-85 岁）。发病时 NIHSS 评分中位数为 21 分（5-36 分）。所有患者均成功再通（TICI 3 或 2b）（TICI 3 占 78.6%，11/14）。4 例患者（28.6%）由于基础粥样硬化狭窄，支架取出后再通不足。3 例患者（21.4%）额外放置了永久性颅内支架，1 例患者（7.1%）单独进行 PTA，最终 1 例患者 TICI 3，3 例患者 TICI 2b。4 例患者（28.6%）单独进行支架取出。器械通过次数平均为 1.3 次（1-3 次）。达到最大再通的中位手术时间为 47 分钟（10-252 分钟）。无器械相关并发症或先前未受累动脉的血栓栓塞闭塞。无症状性颅内出血未发生。3 个月时，28.6%（4/14）患者获得良好的功能结局（mRS 0-2）；总死亡率为 35.7%（5/14）。
BAO 采用可回收支架的多模态血管内方法具有较高的再通率，并发症发生率非常低。基底动脉的动脉粥样硬化血栓性狭窄病变可能仍需要额外的永久性支架置入以实现完全再通。
