Primary aspiration thrombectomy for posterior circulation stroke

Lukas Meyer, Maria Politi, Maria Alexandrou, Michael Tepper, Andreas Kastrup, Christian Roth, Panagiotis Papanagiotou


Purpose: Primary aspiration thrombectomy reports on posterior circulation stroke (PCS) are still rare. There- fore, we aimed to investigate the effectiveness and safety of aspiration as a first-line approach.

Material and Methods: All patients that received thrombectomy for acute ischaemic stroke with the pri- mary aspiration technique for PCS between 07/2015- 12/2018 were retrospectively analysed (n=50). In some cases stent retriever devices were used secondarily. Sta- tistical analysis was performed to identify predictors for early favourable functional outcome (modified Rankin Scale-mRS≤2) and differences between successful as- piration and secondary stent retriever use. Procedural outcomes and safety were evaluated with reference to the thrombolysis in cerebral infarction (TICI) scale, time to recanalisation, rates of symptomatic intracerebral haemorrhage (sICH), and severe adverse events related to the intervention.
Results: Primary aspiration was performed successfully in 66% (33/50) of cases. In 17 of 50 cases (34%) stent re- triever devices were used secondarily. Successful recan- alisation (TICI ≥2b) was achieved in 94% (46/50) of cases. An overall early favourable functional outcome was ob- served in 38% (19/50) of patients at discharge (mRS≤2). Compared to the secondary stent retriever group, the as- piration group showed significantly higher rates of func- tional outcome (45.5% vs. 23.5%, respectively) and suc- cessful recanalisation (TICI≥2b; 100% vs. 82.4%); a lower rate of in-hospital mortality (24% vs. 41.2%); and a faster median recanalisation time (40.5 min vs. 63 min).


schaemic stroke; Posterior circulation; Aspiration thrombectomy

Full Text:



O’Brien JT, Wiseman R, Burton EJ, et al. Cognitive associations of subcortical white matter lesions in older people. Ann N Y Acad Sci 2002; 977: 436–444.

de Groot JC, de Leeuw FE, Oudkerk M, et al. Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol 2000; 47: 145–151.

Schmidt R, Ropele S, Enzinger C, et al. White matter lesion progression, brain atrophy, and cognitive decline: the Austrian stroke prevention study. Ann Neurol 2005; 58: 610–616.

Van der Flier WM, van Straaten ECW, Barkhof F, et al. Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study. Stroke 2005; 36: 2116–2120.

Breteler MM. Vascular risk factors for Alzheimer’s disease: an epidemiologic perspective. Neurobiol Aging 2000; 21: 153–160.

Launer LJ. Demonstrating the case that AD is a vascular disease: epidemiologic evidence. Ageing Res Rev 2002; 1: 61–77.

Yarchoan M, Xie SX, Kling MA, et al. Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias. Brain 2012; 135(12): 3749–3756.

Kling MA, Trojanowski JQ, Wolk DA, et al. Vascular disease and dementias: paradigm shifts to drive research in new directions. Alzheimers Dement 2013; 9(1): 76–92.

Kuller LH, Lopez OL, Newman A, et al. Risk factors for dementia in the cardiovascular health cognition study. Neuroepidemiology 2013; 22: 13–22.

Söderlund H, Nilsson LG, Berger K, et al. Cerebral changes on MRI and cognitive function: the CASCADE study. Neurobiol Aging 2006; 27: 16–23.

Snowdon DA, Greiner LH, Mortimer JA, et al. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 1997; 277: 813–817.

Esiri MM, Nagy Z, Smith MZ, et al. Cerebrovascular disease and threshold for dementia in the early stages of Alzheimer’s disease. Lancet 1999; 354: 919–920.

Scheltens P, Barkhof F, Valk J, et al. White matter lesions on magnetic resonance imaging in clinically diagnosed Alzheimer’s disease. Evidence for heterogeneity. Brain 1992; 115: 735–748.

Scheltens P, Pasquier F, Weerts JG, et al. Qualitative assessment of cerebral atrophy on MRI: inter- and intra-observer reproducibility in dementia and normal aging. Eur Neurol 1997; 37: 95-99.

Davies RR, Scahill VL, Graham, et al. Development of an MRI rating scale for multiple brain regions: comparison with volumetrics and with voxel-based morphometry. Neuroradiology 2009; 51: 491-503.

Fazekas F, Chawluk JB, Alavi A, et al. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 1987; 149: 351-356.

Koedam EL, Lehmann M, van der Flier WM, et al. Visual assessment of posterior atrophy development of a MRI rating scale. Eur Radiol 2011; 21: 2618-2625.

Krainik A, Moreaud O, Cantin S, et al. Morphological subroups in Alzheimer’s disease based on the precuneus atrophy. ΕCR 2011. Poster C-2190. DOI: 10.1594/ecr2011/C-2190.

DelliPizzi S, Franciotti R, Bubbico G, et al. Atrophy of hippocampal subfields and adjacent extrahippocampal structures in dementia with Lewy bodies and Alzheimer’s disease. Neurobiol Aging 2016; 40: 103-109.

Yushkevich PA, Pluta JB, Wang H, et al. Automated volumetry and regional thickness analysis of hippocampal subfields and medial temporal cortical structures in mild cognitive impairment. Hum Brain Mapp 2015; 36(1): 258-287.

Ferreira D, Cavallin L, Larsson EM, et al. Add Neuro Med consortium and the Alzheimer’s Disease. Neuroimaging Initiative. Practical cut-offs for visual rating scales of medial temporal, frontal and posterior atrophy in Alzheimer’s disease and mild cognitive impairment. J Intern Med 2015; 278: 277-290.

Harper L, Barkhof F, Fox NC, et al. Using visual rating to diagnose dementia: a critical evaluation of MRI atrophy scales. J Neurol Neurosurg Psychiatry 2015; 86(11): 1225-1233.

Galton CJ, Gomez-Anson B, Antoun N, et al. Temporal lobe rating scale: application to Alzheimer’s disease and frontotemporal dementia. J Neurol Neurosurg Psychiatry 2001; (2): 165-173.

Scheltens P, Leys D, Barkhof F, et al. Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 1992; 55: 967-972.

Koikkalainen J, Rhodius-Meester H, Tolonen A, et al. Differential diagnosis of neurodegenerative diseases using structural MRI data. Neuroimage Clin 2016; 11: 435-449.

Visser P, Verhey F, Hofman P, et al. Medial temporal lobe atrophy predicts Alzheimer’s disease in patients with minor cognitive impairment. J Neurol Neurosurg Psychiatry 2002; 72(4): 491-497.

Papageorgiou SG, Beratis IN, Horvath J, et al. Amnesia in frontotemporal dementia: shedding light on the Geneva historical data. J Neurol 2016; 263: 657-664.

Irish M, Piguet O, Hodges JR, et al. Common and unique gray matter correlates of episodic memory dysfunction in fronto-temporal dementia and Alzheimer’s disease. Hum Brain Mapp 2014; 35(4): 1422-1435.

Tan RH, Pok K, Wong S, et al. The pathogenesis of cingulate atrophy in behavioral variant frontotemporal dementia and Alzheimer’s disease. Acta Neuropathol Commun 2013; 1: 30.

Harper L, Barkhof F, Scheltens P, et al. An algorithmic approach to structural imaging in dementia. J Neurol Neurosurg Psychiatry 2014; 85: 692-698.

O’Brien JT, Wiseman R, Burton EJ, et al. Cognitive associations of subcortical white matter lesions in older people. Ann N Y Acad Sci 2002; 977: 436–444.

De Groot JC, de Leeuw FE, Oudkerk M, et al. Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol 2002; 47: 145–151.



  • There are currently no refbacks.