We investigated patient characteristics, procedural factors, functional outcome, and mortality associated with mechanical thrombectomy. Furthermore, predictors of outcome were identified.

Early recanalization of acute posterior circulation stroke caused by large vessel occlusion by mechanical thrombectomy with stent retrievers may improve patient outcome.

We analyzed acute posterior circulation stroke patients who underwent thrombectomy between January 2014 till June 2019 using a prospectively maintained single-center stroke database. Successful recanalization was defined as modified TICI scores 2b-3, good prognosis as modified Rankin Score (mRS) 0-2, and mortality as mRS 6 at 90 days. Baseline characteristics such as age, cardiovascular risk factors, NIHSS at admission, pre-interventional pc-ASPECTS, time to recanalization, duration of treatment, extent of reperfusion, and occlusion patterns, discharge NIHSS and post-interventional ICH were evaluated. Target variables (mRS and mortality at 90 days) were investigated in univariate and multivariate analyses.

Among 22 patients, 86.4% were male, 54.5% received IV thrombolysis, 81.8% had pre-interventional pc-ASPECTS of 7 or more, 77.3% achieved successful recanalization, while 59.1% recanalized with one pass intervention. Vessel occluded was 30% basilar, 27.3% posterior cerebral artery, and 22.7% vertebrobasilar artery. Good prognosis was achieved in 45.5% and mortality in 22.7% at 90 days. On univariate analysis, younger age (44.1 vs 55.1, p=0.03), diabetes (66.7% vs 20%, p=0.03), hypertension 83.3% vs 30.0%, p=0.01), absence of IV thrombolysis (p=0.03), pc-ASPECTS of 6 or less (p=0.04) and higher NIHSS at discharge (p<0.001) were associated with poor prognosis. Unfavorable outcome was noted in 100% of patients with symptomatic ICH. Multivariate analysis did not show any significant factors associated with poor prognosis and mortality.

The results demonstrated that unfavorable outcome was associated with presence of vascular risk factors, absence of IV thrombolysis, lower pc-ASPECTS score and symptomatic ICH. Multivariate analysis could not find any independent factor, this could be due to the small cohort size.