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Approaching the Boundaries of Endovascular Treatment in Acute Ischemic Stroke

Multicenter Experience with Mechanical Thrombectomy in Vertebrobasilar Artery Branch Occlusions

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Abstract

Purpose

Little is known about catheter-based endovascular treatment of vertebrobasilar artery branch occlusion (VEBABO) in acute ischemic stroke (AIS). Nonetheless, the experience of mechanical thrombectomy (MT) in distal small sized arteries of the anterior circulation seems promising in AIS. In this multicenter study, we report the feasibility, efficacy and safety of MT in VEBABO.

Methods

Retrospective analysis of consecutive AIS patients treated with MT due to VEBABO including posterior and anterior inferior cerebellar artery (PICA, AICA) and superior cerebellar artery (SCA) occlusions at seven tertiary care centers between January 2013 and May 2020. Baseline demographics and angiographic outcomes including recanalization success of the affected cerebellar arteries and procedural complications were recorded. Clinical outcomes were evaluated by the modified Rankin scale (mRS) at discharge and 90 days.

Results

Out of 668 endovascularly treated posterior circulation strokes we identified 16 (0.02%) cases with MT for VEBABO. Most frequently, MT of the SCA was done (13/16, 81%). Most VEBABOs occurred after MT of initial basilar/posterior cerebral artery occlusion (9/16, 56%). In 10/16 (63%) procedures, the affected VEBABO was successfully recanalized. Out of four patients three (75%) with isolated VEBABO had benefited from endovascular therapy. Subarachnoid hemorrhage was observed in 3/16 (19%) procedures. The rate of favorable outcome (mRS ≤2) was 40% at discharge and 47% at 90-day follow-up. Mortality was 13% (2/15).

Conclusion

The use of MT for VEBABO is rare but appears to be feasible and effective; however, the comparatively high rate of procedure-related hemorrhage highlights that the indications for MT in these occlusion sites should be carefully weighed up.

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Abbreviations

AICA:

Anterior inferior cerebellar artery

AIS:

Acute ischemic stroke

BA:

Basilar artery

CT:

Computed tomography

ENT:

Emboli of new territory

IQR:

Interquartile range

IVT:

Intravenous thrombolysis

LVO:

Large vessel occlusions

MT:

Mechanical thrombectomy

mRS:

Modified Rankin score

NIHSS:

National Institutes of Health stroke scale

PCA:

Posterior cerebral artery

pcASPECTS:

Posterior circulation Alberta stroke program early CT score

PICA:

Posterior inferior cerebellar artery

SAH:

Subarachnoid hemorrhage

SCA:

Superior cerebellar artery

TICI:

Thrombolysis in cerebral infarction

VEBABO:

Vertebrobasilar artery branch occlusion

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Author information

Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany

    Hanna Styczen

  2. Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany

    Sebastian Fischer & Volker Maus

  3. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore

    Leonard LL Yeo & Benjamin Yong-Qiang Tan

  4. Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany

    Christoph J. Maurer & Ansgar Berlis

  5. Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany

    Nuran Abdullayev & Christoph Kabbasch

  6. Department of Neurology, Klinikum Bremen, Bremen, Germany

    Andreas Kastrup

  7. Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany

    Panagiotis Papanagiotou

  8. Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Panagiotis Papanagiotou

  9. Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany

    Christin Clajus & Donald Lobsien

  10. University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland

    Eike Piechowiak & Johannes Kaesmacher

  11. University Institute of Diagnostic and Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland

    Johannes Kaesmacher

  12. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Leonard LL Yeo & Benjamin Yong-Qiang Tan

Authors
  1. Hanna Styczen
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  2. Sebastian Fischer
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  3. Leonard LL Yeo
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  5. Christoph J. Maurer
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  6. Ansgar Berlis
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  7. Nuran Abdullayev
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  8. Christoph Kabbasch
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  9. Andreas Kastrup
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  10. Panagiotis Papanagiotou
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  11. Christin Clajus
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  12. Donald Lobsien
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  13. Eike Piechowiak
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  14. Johannes Kaesmacher
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  15. Volker Maus
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Contributions

Conception and design: VM; acquisition of data: VM, SF, LY, CM, NA, AK, DL, JK; analysis and interpretation of data: VM, HS, LY, BT, AB, CK, PP, CC, EP, JK; drafting the article: HS, VM. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Hanna Styczen.

Ethics declarations

Conflict of interest

H. Styczen, S. Fischer, L.L. Yeo, B. Yong-Qiang Tan, C.J. Maurer, A. Berlis, N. Abdullayev, C. Kabbasch, A. Kastrup, P. Papanagiotou, C. Clajus, D. Lobsien, E. Piechowiak, J. Kaesmacher and V. Maus declare that they have no competing interests relevant to this work.

Ethical standards

According to the guidelines of the respective local ethics committee, ethics approval was given when necessary for this anonymous retrospective study, which was conducted in accordance with the Declaration of Helsinki. The patients’ consent for treatment was obtained (if possible) according to the individual institutional guidelines. Due to the retrospective nature of the study, additional informed consent was deemed unnecessary by the local ethics committees.

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62_2020_970_MOESM1_ESM.docx

Supplement Table 1: Overview of participating centers, inclusion time and overall number of performed thrombectomies within the study period.

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Styczen, H., Fischer, S., Yeo, L.L. et al. Approaching the Boundaries of Endovascular Treatment in Acute Ischemic Stroke. Clin Neuroradiol 31, 791–798 (2021). https://doi.org/10.1007/s00062-020-00970-7

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  • DOI: https://doi.org/10.1007/s00062-020-00970-7

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