E-239 Safety and effectiveness of mechanical thrombectomy for basilar artery occlusions in patients with NIHSS ≤6

Introduction/Purpose

Ischemic strokes due to basilar artery occlusions are associated with a high risk of permanent disability and even mortality. Indications for mechanical thrombectomy of basilar artery occlusions are not clearly defined and lack evidence from large thrombectomy trials. Intravenous tPA remains the standard of care for these patients but, unfortunately, tPA reperfusion rates are overall insufficient in the setting of basilar artery occlusions. We here evaluate the safety and effectiveness of mechanical thrombectomy for patients with basilar artery occlusion and low NIHSS.

Materials and Methods

We retrospectively reviewed our Comprehensive Stroke Center database and identified all patients who underwent mechanical thrombectomy for basilar artery occlusions between June 2017 and December 2021. We then selected those patients with NIHSS ≤6. Successful recanalization was defined as TICI ≥2b and good clinical outcome as an mRS score of ≤2 at 3 months. Patient characteristics and procedural data were also collected.

Results

A total of 29 basilar artery thrombectomies were performed at our institution between June 2017 and December 2021. Of those, 12 patients (9 females) presented with an NIHSS of ≤6. Mean age was 65 years (range 44 to 89 years). Median baseline mRS was 0 (range 0–2). NIHSS at presentation ranged from 2–6 with a median of 4. Five patients received IV tPA (41.7%). Vascular access was through the femoral artery in 6 cases, transradial in 4 cases and via the brachial artery in 2 cases. Except for 2 cases in which aspiration only was performed, the mechanical thrombectomy technique of choice was a combination of stent-retriever thrombectomy and aspiration. Mean number of passes performed was 1.4 (range 1–3 passes) with single pass success in 8 cases (66.7%). Final mTICI score was 2c or 3 in all cases with mTICI 3 in 10 cases (83.3%). No intracranial hemorrhage was observed. Patient NIHSS at discharge improved in 10 cases and remained stable in 1 case. NIHSS 0 was seen in 7 cases (58.3%) at discharge. One patient suffered a cardiac arrest secondary to his poor clinical status (metastatic pancreatic cancer and recent myocardial infarction) and unfortunately expired within 3 weeks. At 3-month, clinical follow-up was available in 10 patients with mRS ranging from 0 to 2 in 9 patients (90%) including 50% of patients returning to their baseline neurological function. The patient with unchanged NIHSS from presentation to discharge had an mRS of 4 but he improved to an mRS of 2 at 1 year.

Conclusion

Mechanical thrombectomy for basilar artery occlusions in patients with low NIHSS is safe and effective with good clinical outcomes at 3 months.

Disclosures

A. Kuhn: None. J. Singh: None. F. Massari: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Consultant for Medtronic Neurovascular, Stryker NeurovascularBalt, Q'Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.