AUTHOR=Kaiser Daniel , Krukowski Pawel , Hädrich Kevin , Winzer Robert , Pallesen Lars-Peder , Gawlitza Matthias , Linn Jennifer , Puetz Volker , Gerber Johannes C. 

TITLE=Association of Regular Thrombus Surface Phenotype With Complete Recanalization in First-Line Contact Aspiration Thrombectomy for Basilar Artery Occlusion

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.666933

DOI=10.3389/fneur.2021.666933

ISSN=1664-2295

ABSTRACT=<p><bold>Objective:</bold> To assess whether angiographic thrombus surface phenotype has an impact on efficacy of contact aspiration (CA) thrombectomy in patients with basilar artery occlusion (BAO).</p><p><bold>Methods:</bold> From January 2016 to December 2019, consecutive stroke patients with a BAO and first-line CA were analyzed in this retrospective study. We assessed baseline and imaging characteristics and treatment and clinical outcomes. We rated thrombus surface phenotype on pre-treatment digital subtraction angiography in a three-reader-consensus setting. Primary outcome was complete recanalization (modified treatment in cerebral ischemia [mTICI] 3 and arterial occlusive lesion [AOL] 3) after first-line CA without additionally stent retriever passes. Data analysis was stratified according to thrombus surface phenotype and complete first-line recanalization.</p><p><bold>Results:</bold> Seventy-eight patients met the inclusion criteria. Median age was 74 years (IQR 64–80), 64% were male, and median baseline NIHSS score was 24 (IQR 7–32). Thirty patients had a regular and 16 patients had an irregular thrombus phenotype. Thrombus surface was not assessable in 32 patients. In patients with a regular phenotype, complete recanalization was more often achieved compared to irregular and non-ratable phenotypes (50 vs. 18.8% and 21.9%; <italic>p</italic> = 0.027). Patients with a regular phenotype [odds ratio [OR] 8.3; 95% confidence interval [CI]: 1.9–35.8; <italic>p</italic> = 0.005], cardioembolic stroke (OR 12.1, 95% CI: 2.0–72.8; <italic>p</italic> = 0.007), and proximal end of the thrombus in the middle basilar artery segment (OR 5.2, 95% CI: 1.0–26.6; <italic>p</italic> = 0.046) were more likely to achieve complete recanalization after first-line CA without rescue therapy.</p><p><bold>Conclusion:</bold> The efficacy of CA may differ according to the angiographic thrombus surface phenotype in patients with BAO. A regular phenotype is associated with higher rates of complete recanalization in first-line CA. However, assessment of thrombus phenotype is frequently not feasible in BAO.</p>