LAUSR

BACKGROUND Some reports suggest the efficacy of mechanical thrombectomy (MT) for acute vertebrobasilar artery (VBA) occlusion. The major aetiologies of VBA occlusion include cardioembolism (CE) and large artery atherosclerosis (LAA). However, the clinical characteristics of each aetiology remain unclear, and they might be important for decision-making related to the indications and strategy of MT. OBJECTIVE This study aimed to compare functional outcomes and factors affecting outcomes between CE and LAA patients with acute VBA occlusion. METHODS This was a retrospective and prospective observational study using data from the Tokyo-tama-REgistry of Acute endovascular Thrombectomy (TREAT), a multicentre registry of MT for acute large vessel occlusion in the Tokyo metropolitan area. Patients with VBA occlusion classified into CE and LAA groups were analysed. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. RESULTS Seventy-nine patients (57 CE and 22 LAA) were eligible from January 2015 to March 2020. Despite significantly shorter puncture-to-recanalization (P2R) and onset-or-last-well known-to-recanalization (O2R) times in the CE group, the primary outcome was not significantly different between the 2 groups (CE 31.6% vs LAA 45.5%, p=0.248). In the subgroup analysis, CE patients had worse clinical outcomes in the onset-or-last-well-known-to-door (O2D) time ≥180 minutes, O2D time 300 ≥minutes, and low pc-ASPECTS (≤7) subgroups. CONCLUSIONS Functional outcomes of VBA occlusion were not significantly different between CE and LAA. Based on the subgroup analysis, patients with CE might have poorer collateral status than patients with LAA, and earlier recanalization might therefore be desired.