Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Andrea M Alexandre, Iacopo Valente, Arturo Consoli, Pietro Trombatore, Luca Scarcia, Mariangela Piano, Nicola Limbucci, Joseph Domenico Gabrieli, Riccardo Russo, Antonio Armando Caragliano, Maria Ruggiero, Andrea Saletti, Guido Andrea Lazzarotti, Marco Pileggi, Mirco Cosottini, Fabio Pilato, Artur Slomka, Francesca Colò, Francesca Giubbolini, Giovanni Frisullo, Giacomo Della Marca, Aldobrando Broccolini, Alessandro Pedicelli, Andrea M Alexandre, Iacopo Valente, Arturo Consoli, Pietro Trombatore, Luca Scarcia, Mariangela Piano, Nicola Limbucci, Joseph Domenico Gabrieli, Riccardo Russo, Antonio Armando Caragliano, Maria Ruggiero, Andrea Saletti, Guido Andrea Lazzarotti, Marco Pileggi, Mirco Cosottini, Fabio Pilato, Artur Slomka, Francesca Colò, Francesca Giubbolini, Giovanni Frisullo, Giacomo Della Marca, Aldobrando Broccolini, Alessandro Pedicelli

Abstract

Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion ("functional" BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0-0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0-0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33-16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16-3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.

Keywords: basilar artery; endovascular thrombectomy; low NIHSS; posterior circulation stroke; stroke.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Enrollment flow-chart.

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