Safety And Effectiveness Of Edoascular Therapy For Basilar Artery Acute Occlusion With Stenosis

Objective:Endovascular treatment of anterior circulation acute ischemic stroke has been proved to be safe and effective.It has became the highest level recommendation of the guidelines for clinical treatment of large vessel occlusion.However,there is still no evidence of endovascular treatment for basilar artery acute occlusion.This is to investigate the safety and effectiveness of endovascular treatment of basilar artery acute occlusion with stenosis.Methods:A retrospective analysis of clinical data of 28 patients in the Changzhou First People's Hospital from January 2013 to November 2018 who underwent mechanical thrombectomy and(or)angioplasty to treat basilar artery stenosis and acute occlusion.They were treated with stent retriver,ADAPT(a direct aspiration first-pass thrombectomy),balloon angioplasty or stent-assisted angioplasty within 6-8h after onset.After surgery blood pressure controlling,antiplatelet therapy,intensive statin and early rehabilitation were adopted.Clinic data included age,sex,medical history,baseline pc-ASPECTS score,Pons-Midbrain Index(PMI),vascular occlusion site,interventional therapy,onset to recanalization time and puncture to recanalization time et al.The National Institute of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)were used to assess the patient's neurological function during admission.The degree of vascular recanalization was evaluated by modified Thrombolysis In Cerebral Infarction(mTICI).Pc-ASPECTS score and Pons-Midbrain Index(PMI)were assessed by MRI 72h after surgery.The prognosis of patients were assessed at 90-day with Modified Rankin Scale.Result:Angiography evaluated vascular recanalization:25 patients(89.3%)had good vascular recanalization(mTICI?2b)and 3 patents(10.7%)had poor vascular recanalization(mTICI ? 2a).On 90 days follow-up,16 patients(57.1%)had better curative effect(mRS?3),12 patients(42.9%)had poor curative effect(mRS>3)and the mortality was 25%.There were no complications of endovascular therapy,such as arterial dissection,retroperitoneal hematoma,puncture hemorrhage or pseudoaneurysm.Single factor analysis results showed that the time from puncture to recanalization(P=0.036),postoperative pc-ASPECTS(P=0.027)and pontine brain index(P=0.031)were statistically significant.Conclusions:Mechanical thrombectomy combined with balloon angioplasty or/and stent implantation on treatment of basilar artery acute occlusion with stenosis has a higher recanalization,which can improve the prognosis and reduce the mortality.The time from puncture to recanalization,postoperative pc-ASPECTS and pontine brain index affected the prognosis of patients.Endovascular treatment of basilar artery acute occlusion with stenosis is effective and safe.