, Volume 60, Issue 6, pp 651–659 | Cite as

Outcome of endovascular treatment for acute basilar artery occlusion in the modern era: a single institution experience

  • Chuanhui Li
  • Wenbo Zhao
  • Chuanjie Wu
  • Shuyi Shang
  • Jian Chen
  • Ming Ren
  • Jiangang Duan
  • Qingfeng Ma
  • Guilin Li
  • Yunzhou Zhang
  • Hongqi Zhang
  • Liqun Jiao
  • Xunming Ji
Interventional Neuroradiology



The beneficial effect of endovascular treatment (EVT) for patients with acute basilar artery occlusion (ABAO) remains uncertain. The purpose of the present study was to evaluate clinical outcome of EVT for patients with ABAO and analyze prognostic factors of good outcome.


From our prospectively established database, we reviewed all patients with ABAO receiving EVT during January 2014 to December 2016. Baseline characteristics and outcomes were evaluated. Favorable functional outcome was defined as modified Rankin Scale score of 0 to 3 assessed at 3-month follow-up. The association between clinical and procedural characteristics and functional outcome was assessed.


Of the 68 patients included, 50 patients (73.5%) received mechanical thrombectomy with stent retriever device. Successful reperfusion (thrombolysis in cerebral infarction grades 2b–3) was achieved in 61 patients (89.7%). Overall favorable functional outcome was reached by 31 patients (45.6%). In univariate analysis, Glasgow Coma Scale sum score, baseline National Institutes of Health stroke scale score (NIHSS), and baseline glycemia level were identified predicting good clinical outcome. Multivariate analysis showed that lower NIHSS was the only independent risk factor of favorable functional outcome (OR 0.832; 95% CI, 0.715–0.968; p = 0.018). No difference of favorable outcomes was observed between the subgroups of time to EVT < 6 h and ≽ 6 h.


Data in the present study suggests that EVT for ABAO patients should be reasonable within 24 h of symptom onset. The most important factor determining clinical outcome is initial stroke severity.


Basilar artery occlusion Endovascular treatment Stent retriever Stroke 


Compliance with ethical standards


This study was funded by the Key Research and Development Program of China (Grant number 2016YFC1301502), the National Science Foundation of China (Grant numbers 81601006 and 81701287), the China Postdoctoral Science Foundation and the Beijing Postdoctoral Research Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Baird TA, Muir KW, Bone I (2004) Basilar artery occlusion. Neurocrit Care 1:319–329CrossRefPubMedGoogle Scholar
  2. 2.
    Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, Engelter ST, Tanne D, Muir KW, Molina CA, Thijs V, Audebert H, Pfefferkorn T, Szabo K, Lindsberg PJ, de Freitas G, Kappelle LJ, Algra A, BASICS study group (2009) Treatment and outcomes of acute basilar artery occlusion in the basilar artery international cooperation study (BASICS): a prospective registry study. Lancet Neurol 8:724–730CrossRefPubMedGoogle Scholar
  3. 3.
    Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ (2005) Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry 76:1238–1241CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Berkhemer OA, Fransen PSS, Beumer D, van den Berg L, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen M, Staals J, Hofmeijer J, van Oostayen J, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk L, Kappelle LJ, Lo RH, van Dijk E, de Vries J, de Kort PL, van Rooij W, van den Berg J, van Hasselt B, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog H, Gerrits DG, van den Berg-Vos R, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam W, Roos YB, van der Lugt A, van Oostenbrugge R, Majoie CB, Dippel DW, MR CLEAN Investigators (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20CrossRefPubMedGoogle Scholar
  5. 5.
    Campbell BC, Mitchell PJ, Kleinig et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018CrossRefPubMedGoogle Scholar
  6. 6.
    Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD, ESCAPE Trial Investigators (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030CrossRefPubMedGoogle Scholar
  7. 7.
    Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A, REVASCAT Trial Investigators (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306CrossRefPubMedGoogle Scholar
  8. 8.
    Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R, SWIFT PRIME Investigators (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295CrossRefPubMedGoogle Scholar
  9. 9.
    Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CBLM, van der Lugt A, de Miquel MA, Donnan GA, Roos YBWEM, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BCV, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trials. Lancet 387:1723–1731CrossRefPubMedGoogle Scholar
  10. 10.
    Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO (2012) Solitaire flow restoration device versus the MERCI retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380:1241–1249CrossRefPubMedGoogle Scholar
  11. 11.
    Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS, TREVO 2 Trialists (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380:1231–1240CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O'Reilly C, Barber PA, Sharma P, Goyal M, Gahn G, von Kummer R, Demchuk AM (2008) Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 39:2485–2490CrossRefPubMedGoogle Scholar
  13. 13.
    Puetz V, Khomenko A, Hill MD, Dzialowski I, Michel P, Weimar C, Wijman CA, Mattle HP, Engelter ST, Muir KW, Pfefferkorn T, Tanne D, Szabo K, Kappelle LJ, Algra A, von Kummer R, Demchuk AM, Schonewille WJ, Basilar Artery International Cooperation Study (BASICS) Group (2011) Extent of hypoattenuation on CT angiography source images in basilar artery occlusion: prognostic value in the basilar artery international cooperation study. Stroke 42:3454–3459CrossRefPubMedGoogle Scholar
  14. 14.
    Archer CR, Horenstein S (1977) Basilar artery occlusion: clinical and radiological correlation. Stroke 8:383–390CrossRefPubMedGoogle Scholar
  15. 15.
    Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D, Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology, Technology Assessment Committee of the Society of Interventional Radiology (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34:e109–e137CrossRefPubMedGoogle Scholar
  16. 16.
    Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Kuelkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G (2007) SITS-MOST investigators. Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study. Lancet 369:275–282CrossRefPubMedGoogle Scholar
  17. 17.
    Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR, American Heart Association Stroke Council (2015) 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:3020–3035CrossRefPubMedGoogle Scholar
  18. 18.
    Gory B, Mazighi M, Blanc R et al (2018) Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever). J Neurosurg 12:1–10CrossRefGoogle Scholar
  19. 19.
    van Houwelingen RC, Luijckx GJ, Mazuri A, Bokkers RP, Eshghi OS, Uyttenboogaart M (2016) Safety and outcome of intra-arterial treatment for basilar artery occlusion. JAMA Neurol 73:1225–1230CrossRefPubMedGoogle Scholar
  20. 20.
    Singer OC, Berkefeld J, Nolte CH, Bohner G, Haring HP, Trenkler J, Gröschel K, Müller-Forell W, Niederkorn K, Deutschmann H, Neumann-Haefelin T, Hohmann C, Bussmeyer M, Mpotsaris A, Stoll A, Bormann A, Brenck J, Schlamann MU, Jander S, Turowski B, Petzold GC, Urbach H, Liebeskind DS, for the ENDOSTROKE Study Group (2015) ENDOSTROKE study group. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 77:415–424CrossRefPubMedGoogle Scholar
  21. 21.
    Bouslama M, Haussen DC, Aghaebrahim A, Grossberg JA, Walker G, Rangaraju S, Horev A, Frankel MR, Nogueira RG, Jovin TG, Jadhav AP (2017) Predictors of good outcome after endovascular therapy for Vertebrobasilar occlusion stroke. Stroke 48:3252–3257CrossRefPubMedGoogle Scholar
  22. 22.
    Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G (2011) Basilar artery occlusion. Lancet Neurol 10:1002–1014CrossRefPubMedGoogle Scholar
  23. 23.
    Bang OY (2014) Intracranial atherosclerosis: current understanding and perspectives. J Stroke 16:27–35CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lee YY, Yoon W, Kim SK, Baek BH, Kim GS, Kim JT, Park MS (2017) Acute basilar artery occlusion: differences in characteristics and outcomes after EndovascularTherapy between patients with andwithout underlying severe atherosclerotic stenosis. AJNR Am J Neuroradiol 38:1600–1604CrossRefPubMedGoogle Scholar
  25. 25.
    Yoon W, Kim SK, Park MS, Kim BC, Kang HK (2015) Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery 76:680–686CrossRefPubMedGoogle Scholar
  26. 26.
    Gao F, Lo WT, Sun X, Mo DP, Ma N, Miao ZR (2015) Combined use of mechanical thrombectomy with angioplasty and stenting for acute basilar occlusions with underlying severe intracranial vertebrobasilar stenosis: preliminary experience from a single Chinese center. AJNR Am J Neuroradiol 36:1947–1952CrossRefPubMedGoogle Scholar
  27. 27.
    Huo X, Gao F, Sun X, Ma N, Song L, Mo D, Liu L, Wang B, Zhang X, Miao Z (2016) Endovascular mechanical Thrombectomy with the solitaire device for the treatment of acute basilar artery occlusion. World Neurosurg 89:301–308CrossRefPubMedGoogle Scholar
  28. 28.
    Berkhemer OA, Jansen IGH, Beumer D et al (2016) MR CLEAN investigators. Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation stroke. Stroke 47:768–776PubMedGoogle Scholar
  29. 29.
    Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B, Lee KH, Liebeskind DS (2011) Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 42:693–699CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Jovin TG, Gupta R, Horowitz MB, Grahovac SZ, Jungreis CA, Wechsler L, Gebel JM, Yonas H (2007) Pretreatment ipsilateral regional cortical blood flow influences vessel recanalization in intra-arterial thrombolysis for MCA occlusion. AJNR Am J Neuroradiol 28:164–167PubMedGoogle Scholar
  31. 31.
    Alemseged F, Shah DG, Diomedi M, Sallustio F, Bivard A, Sharma G, Mitchell PJ, Dowling RJ, Bush S, Yan B, Caltagirone C, Floris R, Parsons MW, Levi CR, Davis SM, Campbell BCV (2017) The basilar artery on computed tomography angiography prognostic score for basilar artery occlusion. Stroke 48:631–637CrossRefPubMedGoogle Scholar
  32. 32.
    Lindsberg PJ, Pekkola J, Strbian D, Sairanen T, Mattle HP, Schroth G (2015) Time window for recanalization in basilar artery occlusion: speculative synthesis. Neurology 85:1806–1815CrossRefPubMedGoogle Scholar
  33. 33.
    Vergouwen MD, Algra A, Pfefferkorn T et al (2012) Time is brain (stem) in basilar artery occlusion. Stroke 43:3003–3006CrossRefPubMedGoogle Scholar
  34. 34.
    van der Hoeven EJ, Schonewille WJ, Vos JA et al (2013) The basilar artery international cooperation study (BASICS): study protocol for a randomised controlled trial. Trials 14:200CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Liu X, Xu G, Liu Y, Zhu W, Ma M, Xiong Y, Zi W, Dai Q, Leung T, Yan B, Davis S, Liebeskind DS, Pereira VM, Nogueira RG, BEST Trial Investigators (2017) Acute basilar artery occlusion: endovascular interventions versus standard medical treatment (BEST) trial-design and protocol for a randomized, controlled, multicenter study. Int J Stroke 12:779–785CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Chuanhui Li
    • 1
  • Wenbo Zhao
    • 2
  • Chuanjie Wu
    • 2
  • Shuyi Shang
    • 2
  • Jian Chen
    • 1
  • Ming Ren
    • 3
  • Jiangang Duan
    • 2
  • Qingfeng Ma
    • 2
  • Guilin Li
    • 1
  • Yunzhou Zhang
    • 2
  • Hongqi Zhang
    • 1
  • Liqun Jiao
    • 1
  • Xunming Ji
    • 1
  1. 1.Department of NeurosurgeryXuanwu Hospital of Capital Medical UniversityBeijingChina
  2. 2.Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
  3. 3.Cerebrovascular Diseases Research InstituteXuanwu Hospital of Capital Medical UniversityBeijingChina

Personalised recommendations