Mechanical Thrombectomy for Basilar Artery Occlusion

Purpose: Acute cerebral infarction due to basilar artery occlusion (BAO) has a poor prognosis and is characterized by a high mortality rate. Moreover, the efficacy of mechanical thrombectomy (MT) and its indications for BAO have yet to be established. In the present study, we retrospectively investigated the prognostic factors of MT for BAO at our hospital.Patients and Methods: This study included 13 consecutive patients (eight men, mean age 76 years) who underwent acute-stage revascularization at our hospital for cerebral infarction associated with basilar artery occlusion over a 66-month period from January 2014 to June 2019. Background and treatment-associated factors of each patient were retrospectively identified, and patient outcomes after 90 days (modified Rankin Scale [mRS] score) were investigated by assigning post-operative patients to the good outcome group (mRS score 0–2) or the poor outcome group (mRS score 3–6) and examining their respective associations with each potential prognostic factor. The following six factors were selected: pre-operative National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation Alberta Stroke Program Early CT Score on diffusion-weighted imaging, time from disease onset or final confirmation of good health to recanalization, thrombolysis in cerebral infarction (TICI) classification, collateral blood circulation from the anterior circulation, and basilar artery occlusion site.Results: The recanalization rate in patients with a TICI grade ≥ 2B was 91%. The good outcome group included 31% of study participants, and the mortality rate was 23%. The mean time to recanalization was 332 min (range: 140–720 min), and the mean pre-operative NIHSS score was 17 (range: 3–30). Associations between background factors and outcomes after 90 days were investigated using the Student’s t-test, and the results showed that a pre-operative NIHSS score ≤ 13 was a significant indicator of a good outcome (p=0.029). None of the other factors was associated with the outcome.Conclusion: The findings of this study revealed that proactive therapeutic interventions in patients with BAO with an NIHSS score ≤13 significantly improved outcomes.