Markus Möhlenbruch
Self-expanding retrievable stents (stent retrievers) are the latest hot topic in the endovascular treatment of ischemic stroke. In April 2010, I performed my first thrombectomy with a stent retriever in a patient with an M1 occlusion. Recent data of our own have demonstrated that adding stent retrievers to a multimodal approach in acute ischemic stroke treatment reduces the time to recanalization and further increases the recanalization rate.1-4 However, while an increasing number of studies investigating the use of stent retrievers in anterior circulation large vessel occlusion have been performed, employment in acute basilar artery occlusion (BAO) has been reported infrequently—and, in most studies, with less than 20 patients.
The purpose of our study was to evaluate the safety and technical feasibility of stent retrievers in the endovascular treatment of acute BAO. We used 2 different stent retrievers without procedural complications. The first 9 patients were treated with the Solitaire FR, and in the following 14 patients, the Revive SE was used. Together with additional intracranial stenting, which reflects the higher incidence of a high-grade stenosis in the posterior circulation with consecutive atherothrombotic occlusions, we found a successful recanalization (meaning TICI 2b–3) of 87.5%.
However, despite the high successful recanalization rate, favorable clinical outcome was limited (mRS 0–2 in 33% of patients). Different predictors influence clinical outcome independently from successful recanalization, such as initial NIHSS score, age, etc. Interestingly, time from onset to endovascular treatment did not exert a strong influence on outcome. This finding is in accordance with the observation that extended treatment windows of up to 12 hours in posterior circulation ischemic stroke are possible if irreversible extended brain stem infarction is ruled out by pretreatment DWI-MRI.
Some of these findings were recently presented at the 12th World Federation of Interventional and Therapeutic Neuroradiology Congress, Buenos Aires, Argentina, November 9–13, 2013.