Efficacy and Procedural Efficiency of Mechanical Thrombectomy Devices in Posterior Circulation Stroke

Linlin Ma¹Zhe Cheng¹Gary Benjamin Rajah^2,3Ho Jun Yun⁴Yuchuan Ding^4*Xiaokun Geng^1,4,5*

• ¹Department of Neurology and Stroke Center, Luhe Hospital, Capital Medical University,, Beijing, China
• ²Department of Neurosurgery, Munson Medical Center, Traverse City.MI, United States
• ³Department of Neurosurgery, Munson Healthcare, Traverse City, MI, United States
• ⁴Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, United States
• ⁵Luhe Institute of Neuroscience, Capital Medical University, beijing, China

Background and Purpose: Posterior circulation stroke patients have worse outcomes after mechanical thrombectomy (MT) and higher mortality than anterior circulation acute ischemic stroke patients (AIS) due to large vessel occlusions (LVO). To determine the ideal recanalization device for posterior circulation LVO strokes, this study compared the operational parameters and prognosis among three commonly used thrombectomy devices.: A total of 99 patients with posterior circulation AIS who underwent mechanical thrombectomy were enrolled. The patients were divided into three groups based on different thrombectomy devices used during the procedure. Patient demographics, procedural metrics, functional outcomes, and symptomatic intracranial hemorrhage (sICH) were assessed. Any association between the devices and favorable clinical outcomes were assessed by logistic regression analysis. Results: A total of 80 patients were analyzed. The Penumbra aspiration catheter revealed a significant advantage for the time of recanalization versus the other devices (32min vs. 44 and 41min). No significant difference was observed in other procedural parameters or functional outcome. There was no significant difference in symptomatic cerebral hemorrhage (sICH), mortality or functional independence after MT among the three groups. Diabetes mellitus, NIHSS score at admission, time from onset to recanalization and occlusion site were associated with functional independence at 90 days, though use of different recanalization devices did not make significant difference. Conclusion: Aspiration achieved vessel recanalization faster than retriever stent during mechanical thrombectomy in posterior circulation AIS. No clear improved functional outcome favored one device over another in this study. The key factors affecting functional outcomes in posterior circulation LVO were presence or absence of diabetes, baseline NIHSS, occlusion site of basilar artery, and TOR time.