Interventions for hypertension and stroke

Coronary stent implantation for acute basilar artery occlusion with underlying stenosis

EuroIntervention 2020;16:e1021-e1028. DOI: 10.4244/EIJ-D-19-00519

Sándor Nardai
Sándor Nardai1,2, MD, PhD; Balázs Kis1, MD; István Gubucz1, MD; Zsolt Berentei1, MD, PhD; Zsolt Vajda1, MD; Péter Orosz1, MD; András Nagy1, MD, DSc; Csaba Óváry1, MD, PhD; Zoltán Nagy1,2, MD; István Szikora1, MD, PhD
1. Department Section of Neurointervention, Semmelweis University Department of Neurosurgery, National Institute of Clinical Neurosciences, Budapest, Hungary; 2. Department Section of Vascular Neurology, Semmelweis University Heart and Vascular Center, Budapest, Hungary

Aims: Our aim was to study the effectiveness of coronary stent implantation during the endovascular treatment (EVT) of acute basilar artery occlusion (BAO) with occlusion-underlying intracranial atherosclerotic stenosis (ICAS).

Methods and results: We retrospectively analysed 91 consecutive BAO patients who underwent EVT between February 2014 and January 2019 in a single, high-volume neurointerventional centre. We studied the effect of immediate coronary stent implantation on the clinical outcome of BAO with occlusion-underlying stenosis. BAO patients with underlying ICAS (n=41) were characterised by longer symptom-onset-to-reperfusion times (231 min vs 173 min, p=0.0020), lower TICI 2b-3 reperfusion rates (65.85% vs 90.00%, p=0.0084), and higher overall mortality (HR 2.021, p=0.0417) compared to the BAO cases without ICAS (n=50). The patients undergoing stenting (n=18) had lower residual basilar artery (BA) stenosis (14.7% vs 81.0%, p<0.0001), higher chance for functional recovery (OR 7.6, p=0.0250) and higher chance of survival (HR 4.163, p=0.0026) compared to the BAO-ICAS cases treated without coronary stents (n=21).

Conclusions: The immediate treatment of the occlusion-underlying stenosis with coronary stents and dual antiplatelet therapy (DAPT) in BAO was associated with improved overall survival and better functional outcomes.

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ischaemic strokeStent retrieversthrombectomy
Interventions for strokeIschaemic strokeOther stroke interventions
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