Research progress in the endovascular treatment of acute basil artery occlusion

doi:10.11817/j.issn.1673-9248.2022.05.014

Abstract

Abstract:

Acute basilar artery occlusion (ABAO) is one of the key causes of ischemic strokes in the vertebrobasilar system, with a high disability and mortality of about 90% and therefore a heavy disease burden. Recent studies indicate that the key to successful treatment of ABAO is to start reperfusion therapy as soon as possible and to save the ischemic penumbra by endovascular treatment (EVT). However, EVT for ABAO is still lack of evidence-based medicine. Hence, we summarize the progress in EVT by comparing different EVTs and analyzing the correlation between preoperative imaging elvaluation and clinical outcome, so as to provide reference for clinical EVT of patients.

Key words: Acute basilar artery occlusion, Endovascular treatment, Preoperative imaging elvaluation

Dongsheng Chen, Meng Zhang, Cailan Zhang, Zhitang Sun. Research progress in the endovascular treatment of acute basil artery occlusion[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(05): 360-365.

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References 51

1	Ye GF, Lu J, Qi P, et al. Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis [J]. Neurointerv Surg, 2019, 11(8): 740-746.
2	Writing Group for the BASILAR Group, Zi W, Qiu Z, et al. Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry [J]. JAMA Neurol, 2020, 77(5): 561-573.
3	缪中荣, 霍晓川. 未来已来: 急性缺血性卒中血管内治疗中国现状 [J]. 中国卒中杂志, 2021, 16(11): 1085-1090.
4	高峰, 徐安定. 急性缺血性卒中血管内治疗中国指南2015 [J]. 中国卒中杂志, 2015, 10(7): 590-606.
5	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2019, 50(12): e344-e418.
6	Chang KC, Chuang IC, Huang YC, et al. Risk factors outperform intracranial large artery steno -sis predicting unfavorable outcomes in patients with stroke [J]. BMC Neurol, 2019, 19(1): 180.
7	Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, et al. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation [J]. Neurointerv Surg, 2019, 11(12): 1174-1180.
8	Weber R, Minnerup J, Nordmeyer H, et al. Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry [J]. Eur J Neurol, 2019, 26(2): 299-305.
9	Wang FZ, Wang JQ, He Q, et al. Mechanical thrombectomy for posterior circulation occlusion: a comparison of outcomes with the anterior circulation occlusion meta analysis [J]. Atheroscler Thromb, 2020, 27(12): 1325-1339.
10	Kumar G, Shahripour RB, Alexandrov AV, Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis [J].Neurointerv Surg, 2015, 7(12): 868-874.
11	Fisher M. Endovascular therapy for basilar-artery occlusion-still waiting for answers [J]. N Engl J Med, 2021, 384(20): 1954-1955.
12	Caplan LR, Wityk RJ, Pazdera L, et al. New England Medical Center Posterior Circulation Stroke Registry Ⅱ. Vascular Lesions [J]. J Clin Neurol, 2005, 1(1): 31-49.
13	Caplan LR, Chung CS, Wityk RJ, et al. New England Medical Center Posterior Circulation Stroke Registry: Ⅰ. Methods, database, distribution of brain lesions, stroke mechanisms, and outcomes [J]. J Clin Neurol, 2005, 1(1): 14-30.
14	Cohen JE, Leker RR, Gomori JM, et al. Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke [J]. J Clin Neurosci, 2016, 34: 70-76.
15	Levy EI, Hanel RA, Boulos AS, et al. Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery [J]. J Neurosurg, 2003, 99(4): 653-660.
16	Yoon W, Kim SK, Park MS, et al. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke [J]. Neurosurgery, 2015, 76(6): 680-686.
17	Ramgren B, Frid P, Norrving B, et al. Endovascular therapy in basilar artery occlusion in Sweden 2016-2019—a nationwide, prospective registry study [J]. Neuroradiology, 2022, 64(5): 959-968.
18	Kasner SE, Gorelick PB. Blue Books of Practical Neurology: Prevention and treatment of ischemic stroke [M]. Oxford, United Kingdom: Butterworth-Heinemann, 2004:1-3.
19	Mullen MT, Pisapia JM, Tilwa S, et al. Systematic review of outcome after ischemic stroke due to anterior circulation occlusion treated with intravenous intraarterial or combind intravenous intraarterial thrombolysis [J]. Stroke, 2012, 43(9): 2350-2355.
20	Schonewhile WJ, Wijman CA, Michel P, et al; BASICS Study Group. Treatment and outcomes of acute basiar artery occlusion in Basiar Artery International Cooperation Study (BASICS): a prospective registry study [J]. Lancet Neurol, 2009, 8(8): 724-730.
21	Lindsberg PJ, Pekkola J, Strbian D, et al. Time window for recanalization in basilar artery occlusion: Speculative synthesis [J]. Neurology, 2015, 85(20): 1806-1815.
22	Burns JD, Rindler RS, Carr C, et al. Delay in diagnosis of basilar artery stroke [J]. Neurocrit Care, 2016, 24(2): 172-179.
23	中国卒中学会, 中国卒中学会神经介入分会, 中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018 [J]. 中国卒中杂志, 2018, 13(7): 706-729.
24	Singer OC, Berkefeld J, Nolte CH, et al; ENDOSTROKE Study Group. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study [J]. Ann Neurol, 2015, 77(3): 415-424.
25	Langezaal LCM, van der Hoeven EJRJ, Mont'Alverne FJA, et al. Endovascular therapy for stroke due to basilar-artery occlusion [J]. N Engl J Med, 2021, 384(20): 1910-1920.
26	Liu XF, Dai QL, Ye RD, et al; BEST Trial Investigators. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial [J]. Lancet Neurol, 2020, 19(2): 115-122.
27	Tao CR, Li R, Zhu YY, et al. Endovascular treatment for acute basilar artery occlusion: A multicenter randomized controlled trial (ATTENTION) [J]. Int J Stroke, 2022, 17(7):815-819.
28	Gao F, Lo WT, Sun X, et al. Combined use of mechanical thrombectomy with angioplasty and stenting for acute basilar occlusions with underlying severe intracranial vertebrobasilar stenosis: preliminary experience from a single chinese center [J]. AJNR Am J Neuroradiol, 2015, 36(10): 1947-1952.
29	Luo G, Gao F, Zhang XL, et al. Intracranial stenting as rescue therapy after failue of mech- anical thrombectomy for basilar artery occlusion: data from the ANGEL-ACT registry [J]. Front Neurol, 2021, 12: 739213.
30	杨营营, 李明利, 徐蔚海. 高分辨磁共振成像在基底动脉粥样硬化性疾病中的临床应用 [J]. 中国卒中杂志, 2017, 12(4): 370-374.
31	Cao J, Xuan J, Chen R, et al. Intra arterial treatment for patients with severe acute vertebrobasilar occlusion: a single-center retrospective study [J]. J Stroke Cerebrovasc Dis, 2017, 26(10): 2376-2382.
32	Fischer U, Kaesmacher J, Mendes PV, et al. Direct mechanical thrombectomy versus combined intravenous and mechanical thrombectomy in large-artery anterior circulation stroke: a topical review [J]. Stroke, 2017, 48(10): 2912-2918.
33	Jauch EC, Saver JL, Adams HJ, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2013, 44(3): 870-947.
34	Maingard J, Shvarts Y, Motyer R, et al. Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke [J]. Intern Med J, 2019, 49(3): 345-351.
35	Nie X, Wang D, Pu Y, et al. Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion [J]. Stroke Vasc Neurol, 2022, 7(3): 190-199.
36	Siow I, Tan BYQ, Lee KS, et al. Bridging thrombolysis versus direct mechanical thrombectomy in stroke due to basilar artery occlusion [J]. Stroke, 2022, 24(1): 128-137.
37	张东焕, 张保朝, 高军, 等. 桥接法与直接取栓法治疗急性后循环缺血性卒中的疗效比较及预后影响因素分析 [J]. 中华解剖与临床杂志, 2021, 26(3): 293-297.
38	沈红健, 沈芳, 尹伟, 等. 基于CT灌注成像的pc-ASPECTS对椎基底动脉闭塞急性缺血性脑卒中预后的预测价值 [J]. 第二军医大学学报, 2022, 43(1): 42-48.
39	高军, 温昌明, 孙军, 等. 基于CTA的后循环ASPECT评分对急性椎基底动脉闭塞患者血管内治疗临床结局的预测作用 [J]. 中华解剖与临床杂志, 2021, 26 (4): 425-430.
40	Tei HK, Uchiyama SC, Usui TR, et al. Posterior circulation ASPECTS on diffusion weighted MRI can be a powerful marker for predicting functional outcome [J]. J Neurol, 2010, 257(5): 767-773.
41	杨海华, 马宁, 刘恋, 等. 急性基底动脉闭塞血管内治疗不良结局的影响因素分析 [J]. 中国现代神经疾病杂志, 2020, 20(5): 399-406.
42	Jiang CC, Fan Y, Li YC, et al. Predictors of favorable outcomes for vertebrobasilar artery occlusion after endovascular therapy within 24 hours of symptom onset [J]. Clin Neurol Neurosurg, 2021, 201: 106422.
43	Berndt MT, Pree D, Kaesmacher J, et al. From perviousness to plaque imaging in acute basilar occlusions: the impact of underlying stenosis and how to detect it [J]. Stroke, 2020, 51(3): 766-774.
44	Hong JM, Choi JY, Lee JH, et al. Impact of posterior communicating artery on basilar artery steno-occlusive disease [J]. J Neurol Neurosurg Psychiatry, 2009, 80(12): 1390-1393.
45	Nie X, Pu YH, Zhang Z, et al. Futile recanalization after endovascular therapy in acute ischemic stroke [J]. Biomed Res Int, 2018, 2018: 5879548.
46	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022 [J]. 中华神经科杂志, 2022, 55(6): 565-580.
47	侯志文, 张圣, 史宗杰, 等. 急性基底动脉闭塞血管内治疗前影像评估与临床预后相关性的研究进展 [J]. 中华神经医学杂志, 2019, 18(10): 991-995.
48	Da Ros V, Meschini A, Gandini R, et al. Proposal for a vascular computed tomography-based grading system in posterior circulation stroke: a single-center experience [J]. J Stroke Cerebrovasc Dis, 2016, 25(2): 368-377.
49	Filep RC, Marginean L, Stoian A, et al. Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review) [J]. Exp Ther Med, 2021, 22(3): 954.
50	佟旭, 孙瑄, 王伊龙, 等. 新型DSA侧支量表用于预测急性基底动脉闭塞血管内治疗后无效再通的单中心研究 [J]. 中华放射学杂志, 2021, 55(2): 173-179.
51	Tong X, An JY, Sun X, et al. A pre-intervention 4-item scale for predicting poor outcome despite successful recanalization in basilar artery occlusion [J]. Transl Stroke Res, 2020, 11(6): 1306 - 1313.

评估策略	最佳截断值	90 d预后		临床应用
评估策略	最佳截断值	敏感度（%）	特异度（%）	临床应用
NCCT-pc-ASPECTS评分^[38]	NCCT-pc-ASPECTS≥8分	69.0	63.0	用于初次筛查，敏感度低
CTA-pc-ASPECTS评分^[39]	CTA-pc-ASPECTS≥8分	72.7	100.0	EVT最常用的筛查工具
CTP-CBV-pc-ASPECTS评分^[40]	CTP-CBV-pc-ASPECTS≥7分	89.7	74.1	广泛应用，敏感性及可靠性较高
RAPID-CBV-pc-ASPECTS评分^[40]	RAPID-CBV-pc-ASPECTS≥8分	79.3	81.5	多模态影像学评估结合RAPID
DWI-pc-ASPECTS评分^[40]	DWI-pc-ASPECTS≥7分	74.0	82.0	预测良好结局的能力较低
DWI-脑干评分（BSS）^[41]	DWI-BSS<8分	75.0	90.0	预测良好结局的能力较高
脑桥-中脑指数（PMI）^[42]	脑桥-中脑指数＜3分	47.8	59.7	简单，常与pc-ASPEC联合使用
CT和CTA的血栓衰减变化（Δt=HUCTA-HUnCT）^[43]	HUCTA-HUnCT＞9.05 HU	84.6	70.0	早期识别ABAO合并BS，使EVT选择更加个性化

评估策略	最佳截断值	90 d预后		临床应用
评估策略	最佳截断值	敏感度（%）	特异度（%）	临床应用
NCCT-pc-ASPECTS评分^[38]	NCCT-pc-ASPECTS≥8分	69.0	63.0	用于初次筛查，敏感度低
CTA-pc-ASPECTS评分^[39]	CTA-pc-ASPECTS≥8分	72.7	100.0	EVT最常用的筛查工具
CTP-CBV-pc-ASPECTS评分^[40]	CTP-CBV-pc-ASPECTS≥7分	89.7	74.1	广泛应用，敏感性及可靠性较高
RAPID-CBV-pc-ASPECTS评分^[40]	RAPID-CBV-pc-ASPECTS≥8分	79.3	81.5	多模态影像学评估结合RAPID
DWI-pc-ASPECTS评分^[40]	DWI-pc-ASPECTS≥7分	74.0	82.0	预测良好结局的能力较低
DWI-脑干评分（BSS）^[41]	DWI-BSS<8分	75.0	90.0	预测良好结局的能力较高
脑桥-中脑指数（PMI）^[42]	脑桥-中脑指数＜3分	47.8	59.7	简单，常与pc-ASPEC联合使用
CT和CTA的血栓衰减变化（Δt=HUCTA-HUnCT）^[43]	HUCTA-HUnCT＞9.05 HU	84.6	70.0	早期识别ABAO合并BS，使EVT选择更加个性化

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