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Advanced Neurology Futile recanalization of acute basilar artery occlusion

1. Introduction study, we evaluated the neurological function of patients at
3 months and explored the relationship between the level
Acute basilar artery occlusion (ABAO) accounts for of inflammatory response, collateral status, and FR.
approximately 10% of all strokes and is distinguished as the
[1]
most severe type due to its high morbidity and mortality . 2. Materials and methods
[2]
In the early stages of ABAO, endovascular treatment
(EVT) was employed to achieve vascular recanalization 2.1. Participants
and reinstate blood perfusion, thus becoming the primary We conducted a retrospective analysis of the clinical and
treatment modality . Previous multi-center cohort studies imaging data collected from patients diagnosed with ABAO
[3]
demonstrated that EVT could increase the recanalization and treated with EVT at our institution between January
rate of ABAO to over 80%. Despite this, nearly half of the 2019 and March 2023. Patients were included in the study
patients with successful recanalization still exhibited poor based on the following inclusion criteria: (i) ≥18 years
prognosis and futile recanalization (FR) [4-6] . Hussein et al. old, (ii) diagnosed with ABAO, (iii) underwent EVT, and
introduced the concept of FR in a multicenter study, defining (iv) completed a successful 3-month follow-up. Exclusion
it as Thrombolysis in Myocardial Infarction (TIMI) grade 3 criteria comprised recanalization failure, incomplete
in patients after EVT with a modified Rankin Scale (mRS) clinical data, time from onset to puncture completion
>2 at 3 months . Subsequently, the concept of FR changed exceeding 24 h, patients with anterior circulation stroke,
[7]
due to the modification of TIMI to modified Thrombolysis contrast agent allergy, severe active bleeding, known
in Cerebral Infarction (mTICI) . It is currently defined bleeding tendency, essential organ dysfunctions (such as
[8]
as the occluded vessel achieving complete recanalization heart, liver, kidney), severe hypertension uncontrollable
(mTICI 2b or 3), but patients are unable to achieve by drugs, and pregnant or lactating women. A total of
functional independence (mRS >2) at 3 months [9,10] . 17 patients were excluded based on these criteria. This
The mechanisms of FR remain obscure, but many study was carried out in compliance with the Declaration
theories are inseparable from reperfusion injury [11,12] . of Helsinki and was approved by the ethics committees of
The rapid reperfusion of ischemic brain tissue initiates a The Affiliated Hospital of Xuzhou Medical University.
sequence of inflammatory reactions and oxidative stress, 2.2. EVT methods
resulting in cellular and blood–brain barrier damage,
ultimately culminating in neurological deterioration . In All patients underwent prompt pre-operative examinations
[13]
recent years, multiple studies have shown that the level of upon admission. Intravenous thrombolysis treatment
systemic inflammatory response caused by acute ischemic was administered within the appropriate time window
stroke (AIS) can be evaluated through peripheral blood- to patients without contraindications for venous
based markers. The systemic inflammation response index thrombolysis. EVT comprised two main procedures:
(SIRI), composed of neutrophil count, platelet count, and (i) Aspiration thrombectomy: The thrombus was aspirated
lymphocyte count, offers a novel inflammatory marker using a 50 mL syringe or aspiration pump as the
that reflects the body’s inflammatory status and immune intermediate catheter approached its core.
function. It is widely applied to evaluate the prognosis (ii) Stent thrombectomy: A microcatheter was navigated
of various diseases, such as malignancies, cardiovascular through the occluded segment with a micro guide
diseases, infections, stroke, and neuroimmune diseases. wire, and thrombectomy was performed through
Furthermore, robust collateral status plays a vital role in negative pressure aspiration following stent release.
maintaining blood perfusion in the ischemic area, including In cases where the vessels remained occluded, the
reducing core infarction and alleviating reperfusion aforementioned procedures could be repeated. However,
injury [14,15] . With an increasing volume of research stent thrombectomy was limited to a maximum of three
dedicated to appraising posterior circulation collateral attempts. Remedial measures, including intra-arterial
status, several evaluation techniques have emerged. thrombolysis, balloon angioplasty, stent implantation,
Digital subtraction angiography (DSA) is the recognized or intra-arterial administration of tirofiban, could be
gold standard for diagnosing cerebrovascular diseases employed as needed.
and provides a superior assessment method of collateral
circulation quality. The angiographic collateral grading 2.3. Clinical and imaging assessment
system for basilar artery occlusion (ACGS-BAO) is a novel Demographic and clinical data were collected, including
DSA-based system for assessing collateral circulation information on age, gender, hypertension, coronary
in the basilar artery and has demonstrated efficacy in heart disease, diabetes, atrial fibrillation, previous stroke
[16]
predicting the clinical prognosis of ABAO patients. In this history, pre-operative systolic and diastolic blood pressure,

Volume 2 Issue 4 (2023) 2 https://doi.org/10.36922/an.1641