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Article Dans Une Revue Journal of Neurointerventional Surgery Année : 2023

Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors

1 Département de Neuroradiologie [Strasbourg]
2 Institut de Chirurgie guidée par l'Image
3 BPPS - Biologie et Pharmacologie des Plaquettes sanguines : hémostase, thrombose, transfusion
4 AHEPA University General Hospital [Thessaloniki]
5 Hôpital Gui de Chauliac [CHU Montpellier]
6 CHU Pitié-Salpêtrière [AP-HP]
7 GRC 14 - BIOSFAST - Groupe de recherche clinique Biomarqueurs d’urgence et de réanimation
8 Service de neuroradiologie [Paris]
9 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
10 Service de neurologie [CHRU Nancy]
11 CHU Bordeaux
12 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
13 INCIA - Institut de Neurosciences cognitives et intégratives d'Aquitaine
14 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
15 IGF - Institut de Génomique Fonctionnelle
16 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
17 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
18 Hôpital Foch [Suresnes]
19 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
20 LTSI - Laboratoire Traitement du Signal et de l'Image
21 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
22 Service de Neuroradiologie [CHU de Bicêtre]
23 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
24 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
25 CHU Caen
26 Hôpital Dupuytren [CHU Limoges]
27 XLIM - XLIM
28 Service de Neurologie [CHU Limoges]
29 GHU Paris Psychiatrie et Neurosciences
30 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
31 Service de neurologie [Rouen]
32 Département Neurologie [CHU Toulouse]
33 Service de radiologie [Vannes]
34 Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes]
35 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
36 Service de Neurologie [Strasbourg]
37 Service de Neurologie [Brest]
38 Service de Neuroradiologie [Brest]
39 CHCB - Centre Hospitalier de la Côte Basque
40 Département de Neuroradiologie [CHU Rouen]
41 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
42 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Sébastien Richard
Gaultier Marnat
Marion Boulanger
  • Fonction : Auteur
Maxime Gauberti
  • Fonction : Auteur
Aymeric Rouchaud
Jean François Albucher
  • Fonction : Auteur
  • PersonId : 1366738
  • IdRef : 270257136

Résumé

Background Endovascular treatment (EVT) for basilar artery occlusions (BAO) is associated with a higher rate of futile recanalization compared with anterior circulation procedures. We aimed to identify the incidence and predictors of poor clinical outcome despite successful reperfusion in current clinical practice. Methods We used data from the ETIS (Endovascular Treatment in Ischemic Stroke) registry, a prospective multicenter observational registry of stroke treated with EVT in France. Patients undergoing EVT for acute BAO from January 2014 to May 2019 successfully treated within 8 hours from onset were included. Predictors of 90-day poor outcome (modified Rankin Scale (mRS) 4–6) were researched within patients with successful (modified Thrombolysis In Cerebral Infarction (mTICI 2b-3)) and excellent (mTICI 2c-3) reperfusion. Results Among 242 patients treated within 8 hours, successful reperfusion was achieved in 195 (80.5%) and excellent reperfusion in 120 (49.5%). Poor outcome was observed in 107 (54.8%) and 60 (50%) patients, respectively. In patients with successful early reperfusion, age, higher initial National Institutes of Health Stroke Scale (NIHSS) score, lower posterior circulation Alberta Stroke Programme Early CT Score (pc-ASPECTS), and absence of prior intravenous thrombolysis were independent predictors of poor outcome. The only treatment factor with an independent predictive value was first-pass mTICI 2b-3 reperfusion (adjusted OR 0.13, 95% CI 0.05 to 0.37, p<0.001). In patients with excellent early reperfusion, independent predictors were age, initial NIHSS score, first-pass mTICI 2c-3 reperfusion, and hemorrhagic transformation on post-interventional imaging. Conclusions Early successful reperfusion with EVT occurred in 80.5% of patients, and the only treatment-related factor predictive of clinical outcome was first pass mTICI 2b-3 reperfusion. Further research is warranted to identify the optimal techniques and devices associated with first pass reperfusion in the posterior circulation.

Domaines

Neurosciences
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Dates et versions

hal-04504282 , version 1 (14-03-2024)

Identifiants

Citer

Raoul Pop, Stephanos Nikolaos Finitsis, Caroline Arquizan, Mahmoud Elhorany, Olivier Naggara, et al.. Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors. Journal of Neurointerventional Surgery, 2023, 15 (5), pp.415-421. ⟨10.1136/neurintsurg-2022-018769⟩. ⟨hal-04504282⟩
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