By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.

SOURCE: van Houwelingen RC, Luijckx GJ, Mazuri A, et al. Safety and outcome of intra-arterial treatment for basilar artery occlusion. JAMA Neurol 2016;73:1225-1230.

Mechanical thrombectomy for large vessel occlusion and ischemic stroke has been widely used based on recent successful randomized trials. However, treatment of basilar artery occlusion has been questioned because of the small number of cases, lack of randomized data, and a history of poor results. These investigators reported results of intra-arterial treatment in patients with basilar artery occlusion, from a single-center retrospective case series of 38 consecutive patients who underwent intra-arterial treatment between 2006 and 2015 at a stroke referral center in the Netherlands. Primary outcome included documentation of adequate recanalization, and favorable outcome was defined as a modified Rankin scale score of 0-3.

In 38 patients with basilar artery occlusion, mean age was 58 years, and 55% were male. Twenty-seven patients (71%) were treated with intravenous thrombolysis before undergoing mechanical thrombectomy, which was applied to 30 patients. Seven patients were treated with intra-arterial thrombolysis. The median NIH stroke scale score was 21 (range 15-32) and median time to intra-arterial treatment was 288 minutes (216-380). Adequate recanalization was achieved in 34 of 38 cases (89%), and functional outcome was favorable in 19 (50%) patients. Symptomatic intracranial hemorrhage occurred in two patients. Overall, these results indicate that mechanical thrombectomy for basilar artery occlusion can be accomplished with a similar success rate as that which has been published in the large multicenter, randomized trials of thrombectomy.