Abstract|Stroke 1| Volume 357, SUPPLEMENT 1, e101, October 15, 2015

Comparative analysis of recanalization treatments in basilar artery occlusion

      Background: Basilar artery occlusion (BAO) is the most devastating form of stroke, and the current wisdom is to reverse it with aggressive revascularization treatments. Recent trials using endovascular stentrievers have shown efficacy in anterior circulation, but did not recruit posterior circulation occlusions. The preferred approach in BAO remains unknown.
      Objective: This study collected published series of recanalization treatments in BAO to determine relative efficacy.
      Patients and methods: We analyzed systematically the reported outcomes produced in 17 cohorts published from 2005 comprising 803 patients. Predictors of futile recanalization (FR; 3-month mRS score 4 to 6) were determined in the largest cohort (162, Helsinki).
      Results: Superior results were achieved by primary thrombectomy with recanalization in 91% and good outcome (mRS 0 to 2) in 36%. Still, there was a substantial FR rate at 60%, which was improved using modern stentrievers only (52.8%). Good outcome was reported by mechanical approaches either alone or on-demand more frequently than by exclusively pharmacological protocols (35.5% vs. 24.4%, p < 0.001) in line with higher recanalization rates (84.1% vs. 70.9%, p < 0.001). In the largest single-center cohort, the most significant predictor was extensive baseline ischemia, increasing the odds of futility 20-fold (95% CI 4.4–92.3, p < 0.001). Ventilation support increased FR 7-fold (2.1–23.7, p < 0.01).
      Conclusion: Modern stentriever approaches have reported superior outcome rates over exclusively pharmacological thrombolysis protocols in BAO. However, still more than half of the recanalizations turn out futile. To improve this, more careful patient selection is needed, especially to exclude patients with an already extended baseline ischemia.