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Endovascular thrombectomy for basilar artery occlusion: translating research findings into clinical practice

LANCET NEUROLOGY (2023)

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Article Clinical Neurology

Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy

Carlo W. Cereda et al.

Summary: This study found that basilar artery occlusion patients with limited regions of severe hypoperfusion had a favorable response to reperfusion following endovascular thrombectomy, while patients with more extensive regions of hypoperfusion did not benefit from endovascular reperfusion.

ANNALS OF NEUROLOGY (2022)

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Article Medicine, General & Internal

Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke The CHOICE Randomized Clinical Trial

Arturo Renu et al.

Summary: This study investigated whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. The results showed that compared with placebo, the use of adjunct intra-arterial alteplase resulted in a greater likelihood of excellent neurological outcome at 90 days.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2022)

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Article Clinical Neurology

Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke

Fana Alemseged et al.

Summary: By developing the POST-NIHSS, the prognostic accuracy for posterior circulation stroke patients with mild-moderate symptoms can be improved, and it can help identify patients with NIHSS<10 who are at higher risk of poor outcome.

STROKE (2022)

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Review Clinical Neurology

First-Line Stent Retriever versus Direct Aspiration for Acute Basilar Artery Occlusions: A Systematic Review and Meta-analysis

Dimitrios Xenos et al.

Summary: SR is associated with lower recanalization rates compared with DA for acute BAO, while DA is associated with shorter procedure duration.

WORLD NEUROSURGERY (2022)

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Review Clinical Neurology

Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease

Jin Soo Lee et al.

Summary: This article focuses on the therapeutic considerations for endovascular treatment of ICAD-related acute LVOS. Mechanical thrombectomy is highly effective in treating embolic occlusions, while ICAD requires more pharmacological and mechanical rescue treatment.

JOURNAL OF STROKE (2022)

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Article Clinical Neurology

Thrombectomy versus Medical Management in Mild Strokes due to Large Vessel Occlusion: Exploratory Analysis from the EXTEND-IA Trials and a Pooled International Cohort

Amrou Sarraj et al.

Summary: In patients with large vessel occlusion (LVO) and mild neurological deficits, stratified by perfusion imaging mismatch, endovascular thrombectomy (EVT) did not show improved clinical outcomes compared to medical management (MM). However, EVT was associated with increased functional independence in patients with target mismatch profile.

ANNALS OF NEUROLOGY (2022)

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Article Clinical Neurology

Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory

Tanya N. Turan et al.

Summary: This study reviewed treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS). The major recommendations include prescribing aspirin and clopidogrel for long-term prevention of stroke, recommending high-intensity statin therapy, maintaining target blood pressure levels, engaging in regular physical activity, and treating other modifiable vascular risk factors. The study also advises against certain procedures such as angioplasty and stenting for stroke prevention in moderate or severe sICAS patients.

NEUROLOGY (2022)

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Article Cardiac & Cardiovascular Systems

Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry

Chunrong Tao et al.

Summary: This study compared the effectiveness and safety of endovascular treatment (EVT) with best medical management (BMM) in strokes caused by acute basilar artery occlusion. The findings showed that EVT was associated with significantly better functional outcomes and survival compared to BMM.

CIRCULATION (2022)

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Article Clinical Neurology

The Problem of Restrictive Thrombectomy Trial Eligibility Criteria

Thanh N. Nguyen et al.

Summary: Since 2015, endovascular trials have revolutionized the management of large vessel occlusion stroke patients. However, the translation of restrictive trial eligibility criteria into guidelines has limited the use of thrombectomy to only highly selected patients. This article proposes a tiered approach to identify treatment beneficiaries more rigorously and to offer more treatment opportunities to those who would otherwise be denied.

STROKE (2022)

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Article Clinical Neurology

Functional Outcomes of Patients ≥85 Years With Acute Ischemic Stroke Following EVT: A HERMES Substudy

Rosalie McDonough et al.

Summary: This study aimed to evaluate the efficacy of endovascular treatment (EVT) for patients aged 85 and above and investigate the influence of age on outcomes. The results showed that EVT treatment in patients aged 85 and above achieved better functional outcomes and lower mortality rates.

STROKE (2022)

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Article Medicine, General & Internal

Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion

Chunrong G. Tao et al.

Summary: This multicenter, prospective, randomized controlled trial in China compared endovascular thrombectomy to best medical care for basilar-artery occlusion stroke. The results showed that endovascular thrombectomy within 12 hours led to better functional outcomes at 90 days but was associated with procedural complications and intracerebral hemorrhage.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

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Editorial Material Medicine, General & Internal

Favorable Outcomes in Endovascular Therapy for Basilar-Artery Occlusion

Wouter J. Schonewille

Summary: Basilar-artery occlusion accounts for a significant proportion of ischemic strokes and patients have largely been excluded from acute stroke trials. Previous randomized trials have provided important insights for future studies involving treatment of basilar-artery occlusion patients.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

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Article Medicine, General & Internal

Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion

T. G. Jovin et al.

Summary: This study investigated the effects and risks of endovascular thrombectomy 6 to 24 hours after basilar-artery occlusion stroke. The results showed that thrombectomy led to a higher percentage of patients with good functional status at 90 days compared to medical therapy alone, but was associated with more procedural complications and cerebral hemorrhages.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

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Article Clinical Neurology

Utility of Severity-Based Prehospital Triage for Endovascular Thrombectomy ACT-FAST Validation Study

Henry Zhao et al.

Summary: Implementation of the ACT-FAST algorithm provides more stroke patients with faster EVT and avoids secondary transfers, with the benefits outweighing the disadvantages, despite some shortcomings.

STROKE (2021)

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Article Medicine, General & Internal

Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis

Tudor G Jovin et al.

LANCET (2021)

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Article Medicine, General & Internal

Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion

L. C. M. Langezaal et al.

Summary: In a randomized trial involving 300 patients with basilar-artery stroke, endovascular thrombectomy was not significantly different from medical therapy with respect to a favorable functional outcome (modified Rankin scale score of 0 to 3) at 90 days, but a clinically significant benefit could not be excluded.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Article Medicine, General & Internal

Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

J. C. Grotta et al.

Summary: In patients eligible for t-PA, mobile stroke units (MSUs) showed better functional outcomes at 90 days compared to emergency medical services (EMS). Patients in the MSU group were more likely to achieve a modified Rankin scale score of 0 or 1 at 90 days.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Article Medicine, General & Internal

Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial

Michael D. Hill et al.

LANCET (2020)

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Article Clinical Neurology

Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial

Xinfeng Liu et al.

LANCET NEUROLOGY (2020)

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Article Clinical Neurology

Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke Results From the Safe Implementation of Treatments in Stroke Registry and Meta-Analysis

Boris Keselman et al.

STROKE (2020)

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Article Clinical Neurology

Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry

Wenjie Zi et al.

JAMA NEUROLOGY (2020)

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Article Clinical Neurology

Posterior circulation stroke: machine learning-based detection of early ischemic changes in acute non-contrast CT scans

Helge C. Kniep et al.

JOURNAL OF NEUROLOGY (2020)

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Article Medicine, General & Internal

Thrombectomy for Stroke in the Public Health Care System of Brazil

Sheila O. Martins et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Article Clinical Neurology

Reperfusion Therapy Frequency and Outcomes in Mild Ischemic Stroke in the United States

Hamidreza Saber et al.

STROKE (2020)

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Article Clinical Neurology

Cerebral blood volume lesion extent predicts functional outcome in patients with vertebral and basilar artery occlusion

Fana Alemseged et al.

INTERNATIONAL JOURNAL OF STROKE (2019)

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Review Neuroimaging

Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis

Gengfan Ye et al.

JOURNAL OF NEUROINTERVENTIONAL SURGERY (2019)

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Review Medicine, General & Internal

Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data

Bruce C. Campbell et al.

LANCET (2019)

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Article Medicine, General & Internal

Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke

H. Ma et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

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Article Neuroimaging

European Stroke Organisation (ESO)-European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke

Guillaume Turc et al.

JOURNAL OF NEUROINTERVENTIONAL SURGERY (2019)

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Article Clinical Neurology

Do Clinicians Overestimate the Severity of Intracerebral Hemorrhage?

Elliot J. Tilling et al.

STROKE (2019)

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Article Medicine, General & Internal

Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke

B. C. V. Campbell et al.

NEW ENGLAND JOURNAL OF MEDICINE (2018)

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Article Clinical Neurology

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Peter Sporns et al.

CEREBROVASCULAR DISEASES (2016)

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Article Medicine, General & Internal

Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

Mayank Goyal et al.

LANCET (2016)

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Article Clinical Neurology

Recanalization treatments in basilar artery occlusion-Systematic analysis

Perttu J. Lindsberg et al.

EUROPEAN STROKE JOURNAL (2016)

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Article Clinical Neurology

Time window for recanalization in basilar artery occlusion Speculative synthesis

Perttu J. Lindsberg et al.

NEUROLOGY (2015)

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Article Clinical Neurology

Lower NIH Stroke Scale Scores Are Required to Accurately Predict a Good Prognosis in Posterior Circulation Stroke

Violiza Inoa et al.

CEREBROVASCULAR DISEASES (2014)

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Article Clinical Neurology

Intravenous Thrombolysis of Basilar Artery Occlusion Thrombus Length Versus Recanalization Success

Daniel Strbian et al.

STROKE (2014)

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Article Clinical Neurology

Thrombolysis of basilar artery occlusion: Impact of baseline ischemia and time

Daniel Strbian et al.

ANNALS OF NEUROLOGY (2013)

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Article Clinical Neurology

Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study

Wouter J. Schonewille et al.

LANCET NEUROLOGY (2009)

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Article Clinical Neurology

Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke

MR Macleod et al.

CEREBROVASCULAR DISEASES (2005)

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