Forced Arterial Suction Thrombectomy with the Penumbra Reperfusion Catheter in Acute Basilar Artery Occlusion: A Retrospective Comparison Study in 2 Korean University Hospitals

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Fig 1.
Flow diagram of the current study.
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Fig 2.
Modified Rankin Scale of each group. Mortality was significantly reduced when patients underwent endovascular treatment with the FAST method compared with local fibrinolysis.
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Fig 3.
Schematic drawings of endovascular treatment for acute BAO. A, Arterial branches are obscured above the occlusive site, and inadvertent hemorrhagic complications can occur when a microwire and microcatheter must be navigated distal to the occlusive site. B and C, The FAST method can avoid this risk because the tip of the Penumbra reperfusion catheter is located only at the proximal end of the clot.

Table 1:

Baseline demographics, neurologic deficits, and hyperacute treatment status

	Fibrinolysis Group	FAST Group	P Value
No. of patients	25	32
Age (yr) (mean)	66.6 ± 10.2	68.3 ± 10.7	.549
Male	21 (84%)	22 (69%)	.184
Hypertension	11 (44%)	21 (66%)	.103
Diabetes mellitus	7 (28%)	9 (28%)	.992
Atrial fibrillation	8 (32%)	11 (34%)	.850
NIHSS score on admission (mean)	19.9 ± 8.1	19.8 ± 8.7	.965
TOAST classification			.737
Atherosclerosis	14 (56%)	15 (47%)
Cardioembolism	7 (28%)	12 (37%)
Mixed or unknown	4 (16%)	5 (16%)
Use of intravenous rtPA	7 (28%)	12 (36%)	.35
Time from onset to puncture (min) (mean)	297.0 ± 125.1	281.4 ± 138.3	.662
Primary endovascular treatment
Urokinase	22 (88%)	–
rtPA	2 (8%)
Tirofiban	1 (4%)
Penumbra	–	32 (100%)
Rescue treatment methods
Stenting	7 (28%)	6 (18.8%)
Tirofiban	2 (8%)	2 (6.3%)
Abciximab	2 (8%)	–
Penumbra	2 (8%)
Solitaire	–	3 (9.4%)

Table 2:

Procedural and clinical outcomes

	Fibrinolysis Group	FAST Group	P Value
Procedure time (min) (mean)	113.3 ± 65.4	75.5 ± 42.2	.016
Time from onset to final angiography (min) (mean)	419.5 ± 144.7	364.7 ± 145.2	.163
Successful revascularization	15 (60%)	28 (88%)	.017
Intracranial hemorrhage			.157
Hemorrhagic transformation type 1	7 (29%)	4 (13%)
Hemorrhagic transformation type 2	–	–
Parenchymal hematoma type 1	–	–
Parenchymal hematoma type 2	1 (4%)	–
SAH	2 (8%)	2 (6%)	.797
NIHSS score at discharge (mean)	20.2 ± 11.8	9.2 ± 12.8	.066
Fair outcome at 3 months	2 (8%)	11 (34%)	.019
Mortality	17 (68%)	8 (25%)	.001
Successful revascularization with the primary stand-alone technique	13 of 21 (61.9%)	24 of 26 (92.3%)	.011
Procedure time of the primary stand-alone technique (min) (mean)	91.1 ± 44.6	66.2 ± 34.0	.037
Fair outcome at 3 months with the primary stand-alone technique	1 of 21 (4.8%)	10 of 26 (38.5%)	.007

Table 3:

Multiple logistic regression model for fair outcome at 3 months

Variables	OR (95% CI)	P Value
Age	0.951 (0.881–1.027)	.199
Sex	0.135 (0.013–1.389)	.092
Initial NIHSS score	0.914 (0.828–1.009)	.073
Intravenous rtPA	3.749 (0.685–20.512)	.128
FAST method	7.768 (1.246–48.416)	.028
Successful revascularization	4.339 (0.266–70.698)	.303

Table 4:

List of revascularization treatment studies for acute basilar artery occlusion

Reference	Method	No. of Patients	Age (yr)	NIHSS on Admission	Good Outcome	Fair Outcome	Mortality	TIMI 2–3	TICI 2b-3	sICH	SAH
Arnold et al (2004)³¹	Urokinase	40	58 (median)	18 (median)	35%	47%	42%	60%	–	5%	–
Lutsep et al (2008)¹³	Merci	27	58 (median)	22 (median)	33%	41%	44%	78%	–	19%	11%
Roth et al (2011)¹⁰	Standard Penumbra System	12	70 (median)	28 (median)	33%^{^a}	50%^{^a}	33%^{^a}	83%^{^b}	–	–	–
Mourand et al (2014)³⁰	Solitaire	31	61 (mean)	38 (median)	35%	–	32%	–	74%	16%	–
Espinosa de Ruedz et al (2013)²⁸	Solitaire, Trevo	18	68 (mean)	20 (mean)^{^c}	50%	–	22%	–	94.4%	–	6%
Current study, fibrinolysis	Urokinase, rtPA, tirofiban	25	67 (mean)	20 (mean)	8%	8%	68%	–	36%	4%	8%
Current study, FAST	FAST method	33	68 (mean)	20 (mean)	22%	35%	21%	–	79%	0%	6%

Note:—TIMI indicates Thrombolysis in Myocardial Infarction; sICH, symptomatic intracerebral hemorrhage.
↵a Scales were evaluated before discharge.
↵b Definition of recanalization was not clearly documented.
↵c NIHSS score on admission was evaluated only in nonintubated patients (12 of 18).