Wischmann Johannes, Zimmermann Hanna, Keidel Linus, Liebig Thomas, Nolte Christian H, Kellert Lars
Department of Neurology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
Institute for Neuroradiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
J Neurointerv Surg. 2025 Jun 1;17(e2):e393-e399. doi: 10.1136/jnis-2024-021797.
Endovascular treatment has become the standard care for acute basilar artery occlusion (BAO). Uncertainty persists about the optimal thrombectomy technique.
To compare aspiration thrombectomy with stent retriever thrombectomy in patients with BAO in a multicenter real-world patient population.
We analyzed data from the German Stroke Registry-Endovascular Treatment (GSR-ET). Patients with isolated BAO who underwent either aspiration or stent retriever thrombectomy were compared, including propensity score matching (PSM). The primary outcome measure was the modified Rankin Scale shift analysis at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), procedure complications, and metrics.
Of 13 082 patients in the GSR-ET, 387 patients (mean age 72.0±13.1 years; 45.0% female) fulfilled the inclusion criteria. The thrombectomy technique was aspiration only in 195 (50.4%) and stent retriever only in 192 (49.6%) patients. Functional outcome did not differ between the groups, either before (common OR (cOR) 0.94; 95% CI 0.64 to 1.38) or after PSM (cOR=1.37; 95% CI 0.90 to 2.09). There was no significant difference in sICH (2.6 vs 5.5%; P=0.231; OR=0.46; 95% CI 0.14 to 1.47), but aspiration thrombectomy demonstrated fewer procedure-related complications (4.6% vs 12.5%; P=0.017), a shorter procedure duration (24 vs 48 min; P<0.001), and higher first pass recanalization rates (75.1% vs 44.8%; P<0.001).
In this study both aspiration and stent retriever thrombectomy showed equal efficacy in terms of functional outcome in patients with BAO. However, procedure complications and metrics might favor aspiration over stent retriever thrombectomy.
血管内治疗已成为急性基底动脉闭塞（BAO）的标准治疗方法。关于最佳取栓技术仍存在不确定性。
在多中心真实世界患者群体中比较BAO患者的抽吸取栓术和支架取栓器取栓术。
我们分析了来自德国卒中登记-血管内治疗（GSR-ET）的数据。对接受抽吸或支架取栓器取栓术的孤立性BAO患者进行比较，包括倾向评分匹配（PSM）。主要结局指标是90天时的改良Rankin量表变化分析。次要结局包括症状性颅内出血（sICH）、手术并发症和指标。
在GSR-ET的13082例患者中，387例患者（平均年龄72.0±13.1岁；45.0%为女性）符合纳入标准。取栓技术仅抽吸的患者有195例（50.4%），仅使用支架取栓器的患者有192例（49.6%）。两组之间的功能结局在PSM之前（共同OR（cOR）0.94；95%CI 0.64至1.38）或之后（cOR=1.37；95%CI 0.90至2.09）均无差异。sICH无显著差异（2.6%对5.5%；P=0.231；OR=0.46；95%CI 0.14至1.47），但抽吸取栓术显示出较少的手术相关并发症（4.6%对12.5%；P=0.017）、较短的手术时间（24对48分钟；P<0.001）和更高的首次再通率（75.1%对44.8%；P<0.001）。
在本研究中，抽吸取栓术和支架取栓器取栓术在BAO患者的功能结局方面显示出相同的疗效。然而，手术并发症和指标可能更倾向于抽吸取栓术而非支架取栓器取栓术。
