Thrombectomy for Posterior Circulation Stroke: Predictors of Outcomes in a Brazilian Registry

World Neurosurg. 2021 Mar:147:e363-e372. doi: 10.1016/j.wneu.2020.12.060. Epub 2020 Dec 17.


Background: Acute basilar artery occlusion is a devastating life-threatening condition. Early recanalization is the therapeutic goal in patients with acute ischemic stroke. Despite the high rates of recanalization achieved with modern devices for basilar occlusions, many patients have had poor clinical outcomes. This study aimed to assess the predictors of good and poor outcomes among patients with basilar artery occlusion treated with thrombectomy.

Methods: A consecutive registry of 80 patients was included in this retrospective study. The primary end point was to access variables associated with neurologic outcomes defined by a modified Rankin Scale (mRS) score of 0-2, symptomatic intracranial hemorrhage (sICH), and mortality at 3 months follow-up.

Results: Recanalization was achieved in 86.2%, and the sICH rate was 8.7%. A good neurologic outcome (mRS score 0-2) was observed in 26.2% and a moderate outcome (mRS score 0-3) in 32.5% of patients. The mortality was 38.7% at 3 months follow-up.

Conclusions: After thrombectomy for posterior circulation strokes, young patients, V4-proximal basilar occlusion, (high) baseline posterior circulation Alberta Stroke Program Early CT Score, and complete recanalization were independent predictors of good neurologic outcomes. Failure to recanalize was strongly related to sICH and mortality. In addition, diabetes, atrial fibrillation, and baseline National Institutes of Health Stroke Scale scores ≥10 had an independent association with mortality. This study contributes to the knowledge required to optimize recanalization treatments for posterior circulation strokes and may help to improve future clinical studies.

Keywords: Basilar artery occlusion; Posterior circulation; Stroke; Thrombectomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arterial Occlusive Diseases / etiology
  • Arterial Occlusive Diseases / surgery
  • Brain Ischemia / etiology
  • Brain Ischemia / surgery*
  • Brazil
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Intracranial Hemorrhages / etiology
  • Intracranial Hemorrhages / surgery*
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Stroke / surgery*
  • Thrombectomy* / adverse effects
  • Thrombectomy* / methods
  • Treatment Outcome
  • Vertebrobasilar Insufficiency / surgery*