Journal of Korean Neurosurgical Society

  • 제60권6호
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  • Pages.635-643
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  • 2017
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Effectiveness and Safety of Mechanical Thrombectomy with Stent Retrievers in Basilar Artery Occlusion : Comparison with Anterior Circulation Occlusions

  • Hu, Soo Young (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yi, Ho Jun (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dong Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hong, Jae Taek (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Sang Won (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2017.04.17
  • 심사 : 2017.08.02
  • 발행 : 2017.11.01
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초록

Objective : Acute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO). Methods : In total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Radiological results were used to evaluate thrombolysis in cerebral infarction (TICI) scores and successful recanalization was defined by TICI 2b or 3. Results : Mean NIHSS scores at 24 hours and 30 days were significantly higher in the BAO group than the ACO group (p=0.021, p=0.001). mRS at 90 days was significantly higher in the BAO group (4.2) compared with the ACO group (3.0) (p=0.003). The BAO group (2.0) performed fewer stent retriever passages than the ACO group (2.7) (p=0.049). There were no significant differences between the two groups in terms of complications, but the BAO patients experienced a higher mortality (16.6%) rate than ACO patients (5.8%) (p=0.001). In subgroup analysis of BAO, patients with short procedure times achieved successful recanalization (p=0.001) and successfully recanalized patients exhibited more favorable mRS at 90 days (p=0.027). Conclusion : In our study, mechanical thrombectomy of BAO patients showed worse clinical outcome and higher mortality rate than ACO patients. However, mechanical thrombectomy with a stent retriever in BAO is an effective treatment, because successfully recanalized patients showed good clinical outcome in BAO patients.

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참고문헌

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피인용 문헌

  1. Response to the Letter “Future challenges of stroke treatment” vol.52, pp.3, 2018, https://doi.org/10.1016/j.pjnns.2018.02.006
  2. Stent Retriever Thrombectomy Potentially Increases the Recanalization Rate, Improves Clinical Outcome, and Decreases Mortality in Acute Basilar Occlusion: A Systematic Review and Meta-Analysis vol.9, pp.2, 2017, https://doi.org/10.1159/000499665
  3. Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee vol.11, pp.10, 2019, https://doi.org/10.1136/neurintsurg-2019-014873
  4. Imaging-based Selection for Endovascular Treatment in Stroke vol.39, pp.6, 2017, https://doi.org/10.1148/rg.2019190030
  5. Patient-reported, health-related, quality of life after stroke thrombectomy in clinical practice vol.95, pp.12, 2020, https://doi.org/10.1212/wnl.0000000000010356
  6. Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis vol.15, pp.8, 2020, https://doi.org/10.1177/1747493020909634
  7. Mechanical Thrombectomy for Posterior Circulation Occlusion: A Comparison of Outcomes with the Anterior Circulation Occlusion – A Meta-Analysis vol.27, pp.12, 2017, https://doi.org/10.5551/jat.54221
  8. A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy vol.50, pp.2, 2017, https://doi.org/10.1159/000512609
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