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. 2023 Jun;33(2):483-490.
doi: 10.1007/s00062-022-01236-0. Epub 2022 Dec 2.

Exact Basilar Artery Occlusion Location Indicates Stroke Etiology and Recanalization Success in Patients Eligible for Endovascular Stroke Treatment

Matthias A Mutke  1 , Arne Potreck  1 , Niclas Schmitt  1 , Fatih Seker  1 , Peter A Ringleb  2 , Simon Nagel  2 , Markus A Möhlenbruch  1 , Martin Bendszus  1 , Charlotte S Weyland  1 , Jessica Jesser  3
Affiliations

Exact Basilar Artery Occlusion Location Indicates Stroke Etiology and Recanalization Success in Patients Eligible for Endovascular Stroke Treatment

Matthias A Mutke et al. Clin Neuroradiol. 2023 Jun.

Abstract

Introduction: Endovascular stroke treatment (EST) is commonly performed for acute basilar artery occlusion (BAO). We aimed to identify the role of the exact location of BAO in patients receiving EST regarding the stroke etiology, recanalization success and prediction of favorable clinical outcome.

Methods: Retrospective analysis of 191 consecutive patients treated for BAO with EST from 01/2013 until 06/2021 in a tertiary stroke center. Groups were defined according to exact location of BAO in I: proximal third, II: middle third, III: distal third and IV: tip of the basilar artery. Univariate and multivariate analyses were performed for BAO location comparing stroke etiology, recanalization result and favorable clinical outcome according to mRS 0-3 90 days after stroke onset.

Results: Occlusion sides types I-IV were evenly distributed (37, 36, 60 and 58 patients). Types I and II were more often associated with large artery atherosclerosis (50 vs. 10 patients, p < 0.001). Distal/tip occlusion (types III/IV) occurred mostly in cardiac embolism or embolic stroke of unknown source (89 vs. 12 in types I/II, p < 0.001). Occlusion site correlated with the underlying stroke etiology (AUC [Area under the curve] 0.89, p < 0.0001, OR [odds ratio] for embolism in type IV: 245). Recanalization rates were higher in patients with distal occlusions (type III/IV OR 3.76, CI [95% confidence interval] 1.51-9.53, p = 0.0076). The BAO site is not predicting favorable clinical outcome.

Conclusion: The exact basilar artery occlusion site in patients eligible for endovascular stroke treatment reflects the stroke etiology and is associated with differing recanalization success but does not predict favorable clinical outcome.

Keywords: Basilar artery occlusion; Clinical outcome prediction; Mechanical thrombectomy; Recanalization success; Stroke; Stroke causes.

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Conflict of interest statement

M.A. Mutke, A. Potreck, N. Schmitt, P.A. Ringleb, F. Seker, C.S. Weyland and J. Jesser declare that they have no competing interests. S. Nagel has no related disclosures, unrelated disclosures: consultancy: Brainomix, Boehringer Ingelheim; payment for lectures including service on speakers bureaus: Pfizer, Medtronic, Bayer AG. M.A. Möhlenbruch has no related disclosures, unrelated disclosures: board membership: Codman; consultancy: Medtronic, MicroVention, Stryker; Grants/Grants Pending: Balt*, MicroVention*; payment for lectures including service on speakers bureaus: Medtronic, MicroVention, Stryker; *money paid to the institution. M. Bendszus has not related disclosures, unrelated disclosures: grants and personal fees from Bayer, Codman, Guerbet, Medtronic and Novartis; grants from the German Research Council (DFG), European Union, Hopp Foundation, Siemens, and Stryker; personal fees from BBraun, Böhringer Ingelheim, Roche, Teva, and Vascular Dynamics.

Figures

Fig. 1
Fig. 1
Classification of the different basilar artery occlusion locations. Anterior inferior cerebellar artery (AICA) could be occluded in either type I or type II occlusions due to the artery’s variable origin. Type I are proximal, type II middle, type III distal and type IV tip of the basilar artery occlusions
Fig. 2
Fig. 2
Classification of basilar artery occlusion location. Type I are proximal, type II middle, type III distal and type IV tip of the basilar artery occlusions. Exemplary images show first intracranial angiographic run during endovascular stroke treatment in four different patients with the four different occlusion locations. a Left vertebral artery (VA) with contrasted posterior inferior cerebellar artery (PICA) and occlusion at basilar artery (BA) root. b Left VA with PICA and proximal occlusion of BA directly distal to AICA origin. c Right vertebral artery with contrasted PICA, contralateral V4 segment of VA and BA until occlusion proximal to superior cerebellar arteries (SuCA). d Left VA with contrasted contralateral V4 segment of VA, BA with occlusion distal to SuCA origin
Fig. 3
Fig. 3
Distribution of stroke etiology across four different basilar artery occlusion locations. ESUS embolic stroke of unknown source. Type I are proximal, type II middle, type III distal and type IV tip of the basilar artery occlusions
See this image and copyright information in PMC

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