Stent placement as rescue treatment in acute basilar artery occlusion

We investigated the etiology, safety and efficacy of endovascular treatment with and without stent placement as rescue treatment in patients with acute ischemic stroke due to basilar artery occlusion (BAO).

A Single-center retrospective observational study in consecutive patients with BAO treated with endovascular procedures, divided into stent and non-stent groups. Outcomes of interest were: stroke etiology; recanalization of the basilar artery defined as mTICI ≥ 2b; any intracranial hemorrhage; poor functional outcome (mRS 4-6) at 3 months. Independent associations were investigated with multivariable logistic and ordinal regression analyses adjusted for age, sex, NIHSS, rt-PA use and time-to-groin.

The analysis included 121 patients with a mean age of 70 (± 14) years; 48 (40%) were female. The median NIHSS score was 14 (IQR 6-36). Stent placement was performed in 28 patients (23%), mainly in those with atherosclerosis and artery dissection. Recanalization occurred in 110 (91%) patients, 79% in the stent group patients and 94% in the non-stent group. Ordinal analysis demonstrated higher risk of worse outcome in the stent group (OR = 3.73; 95%CI = 1.46-9.57); however, all patients without vessel recanalization had poor functional outcome. Periprocedural complications, particularly vessel perforation (14% vs 2%, p < 0.001), were more frequent in the stent group, whereas intracranial hemorrhage was similar between groups (7% vs 2%, p = 0.200).

Stent placement was more frequent in patients with stroke due to atherosclerosis or artery dissection and was associated with higher rates of procedural complications and poor functional outcome. However, stenting represents an acceptable option for rescue therapy in BAO due to the high burden of disease in patients who did not achieve vessel recanalization.