Clinical outcomes of mechanical thrombectomy following intravenous administration of recombinant tissue-type plasminogen activator for basilar artery occlusion

Abstract

Objective: Mechanical thrombectomy (MT) following intravenous administration of recombinant tissue-type plasminogen activator (IV-rt-PA) is considered an effective treatment for the occlusion of the internal carotid artery or the M1 segment of the middle cerebral artery. However, its efficacy in treating basilar artery (BA) occlusion is still unclear. In order to evaluate the efficacy of MT in treating BA occlusion, we aimed to analyzed the clinical outcomes of those patients who had undergone MT following IV-rt-PA administration.

Patients and methods: We retrospectively analyzed the clinical outcomes of 11 patients with BA occlusion who had undergone MT following IV-rt-PA administration between January 1, 2015, and March 31, 2019.

Results: The patients consisted of 8 men and 3 women. The mean (±standard deviation) age was 73 ± 9.4 years. Stroke subtypes were found to be atherothrombosis in 2 patients, cardiogenic embolism in 6, arterial dissection in 1, and an unknown cause in 2. The median pretreatment scores were 9 on the Glasgow Coma Scale (GCS) and 25 on the National Institutes of Health Stroke Scale. The time elapsed from onset of the stroke to reperfusion was 281 min. Successful reperfusion, characterized by a modified Thrombolysis in Cerebral Infarction grade ≥ 2b, was achieved in all patients. The 3-month outcomes were good [modified Rankin Scale (mRS) 0-2] in 5 patients and poor (mRS 3-6) in 6 patients. The pretreatment median GCS scores were significantly higher in patients with a good outcome compared to that in those with a poor outcome with scores of 11 and 7.5, respectively (P = 0.044). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score on the GCS was 9.5 [area under the curve (AUC), 0.867; sensitivity, 0.8; specificity, 1.0]. Complications occurred in 1 patient with arterial dissection who had developed a subarachnoid hemorrhage and later died.

Conclusion: The results of the present study suggests that the pretreatment GCS score might affect the clinical outcomes in patients with BA occlusion who underwent MT following IV-rt-PA therapy.

Keywords: Basilar artery occlusion; Glasgow Coma Scale; Ischemic stroke; Mechanical thrombectomy; Outcome; Recombinant tissue-type plasminogen activator.