Basilar Stenosis Reduces the Impact of Successful Recanalization on Outcome in Basilar Artery Occlusion
Moritz R. Hernandez Petzsche,
Philip Hoelter,
Sebastian Rühling,
Julian Schwarting,
Benno Ikenberg,
Silke Wunderlich,
Christian Maegerlein,
Claus Zimmer,
Maria Berndt-Mück,
Tobias Boeckh-Behrens
Affiliations
Moritz R. Hernandez Petzsche
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Philip Hoelter
Department of Neuroradiology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
Sebastian Rühling
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Julian Schwarting
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Benno Ikenberg
Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Silke Wunderlich
Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Christian Maegerlein
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Claus Zimmer
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Maria Berndt-Mück
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Tobias Boeckh-Behrens
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
Background: Evidence from randomized controlled trials has shown a benefit for endovascular treatment in basilar artery occlusion. We aimed to show the effect of the recanalization result on outcome and determine the role of underlying basilar stenosis in a real-world setting. Methods: A retrospective, single-center study of patients who received endovascular treatment for basilar artery occlusion from March 2008 to June 2022 was conducted. Clinical and outcome characteristics were gathered. Multivariate logistic regression analysis was performed to predict poor outcomes (post-treatment mRS 5 or 6). MRS shift analysis was performed. Results: This study includes 210 patients (mean age, 71.4 years +/− 13.3 [standard deviation]; 124 men). The variables age (OR, 1.04; 95% CI: 1.01–1.08; p = 0.014), underlying basilar stenosis (OR: 4.86; 95% CI: 2.15–10.98; p p p = 0.022) independently predicted a poor outcome. Patients with occlusions due to underlying stenosis had significantly worse recanalization rates. Median post-treatment mRS in all patients with embolic occlusion was 4; IQR, 2–5 (only patients with embolic occlusion: mTICI 0-2a, median: 5 [IQR, 4–5.5]; mTICI 2b, median: 4 [IQR, 2.5–6]; mTICI 3, median: 3 [IQR, 1–5]; p = 0.037). Median post-treatment mRS in all patients with occlusions due to underlying stenosis was 5; IQR, 4–6 (only patients with embolic occlusions: mTICI 0-2a, median: 6 [IQR, 4.5–6]; mTICI 2b, median: 6 [IQR, 4.25–6]; mTICI 3, median: 5 [IQR, 3.5–5.25]; p = 0.059). Conclusions: Successful recanalization is essential for preventing poor outcomes in basilar artery occlusion. Underlying basilar stenosis diminishes the effect of successful recanalization on the overall outcome.
