Basilar Artery Occlusion: Not as Simple as Restoring Flow

Anthony S. Kim, MD, MAS reviewing Singer OC et al. Ann Neurol 2015 Mar.

Recanalization did not independently translate into better clinical outcomes for basilar artery stroke, but study design limitations preclude drawing definitive conclusions.

Recent randomized trials of endovascular stroke treatment shed little light on the care of patients with basilar artery occlusion because these patients were specifically excluded from these studies. Registries also have failed to provide strong evidence for a clear benefit, although these studies have often been limited by small sample sizes or by the use of intra-arterial thrombolysis only or of earlier-generation mechanical embolectomy devices, rather than newer stent retrievers.

In this study, researchers identified 148 consecutive patients with a demonstrated basilar artery occlusion on an initial catheter angiogram who received endovascular stroke treatment at 11 centers in Germany and Austria from 2011 to 2013. A majority (59%) had already received intravenous thrombolysis, most (84%) were treated with stent retrievers, and most (79%) achieved recanalization. Certain patient- and procedure-related factors that were previously associated with clinical outcomes were also demonstrated here (e.g., stroke severity and age), and collateral status was rigorously determined and associated with improved outcomes as well. Although the use of stent retrievers was associated with good recanalization, recanalization itself was not independently associated with improved outcomes.

CITATION(S):

Singer OC et al. Mechanical recanalization in basilar artery occlusion: The ENDOSTROKE study. Ann Neurol 2015 Mar; 77:415.