{
  "abstract": "Background Mechanical thrombectomy (MT) is effective for acute basilar artery occlusion (BAO), but the optimal technique for rapid recanalization and improved outcomes remains unclear.Objective We compared stent retriever (SR), contact aspiration (CA), and combined SR plus CA techniques as first-line approaches during MT for BAO.Methods We emulated a hypothetical trial comparing CA, SR, and combined technique as first-line in BAO patients. The primary outcome was first-pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) 3 with one pass of MT. Secondary outcomes included modified FPE (mFPE), functional outcome at 90 days, successful recanalization, and safety outcomes. We used inverse probability weighting (IPW) adjusted for prespecified covariates.Results The study included 960 BAO patients: 570 treated with CA, 268 with SR, and 122 with combined technique as the first approach. After applying IPW, SR was associated with lower odds of FPE (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.90) and of mFPE (aOR 0.48, 95% CI 0.33 to 0.70) compared with CA. No differences were found between the combined technique and either SR or CA. A 90-day modified Rankin Scale (mRS) 0–3 after mFPE was less frequent with SR (aOR 0.57, 95% CI 0.38 to 0.85) and with combined technique (aOR 0.50, 95% CI 0.28 to 0.89) compared with CA. Additionally, combined technique showed lower odds of mRS 0–1 at 90 days compared with CA (aOR 0.56, 95% CI 0.33 to 0.94).Conclusions In BAO patients, CA was more effective than SR for complete and successful recanalization after first pass and resulted in better outcomes after mFPE as compared with other techniques. Less traumatic approaches might be preferred as first-line in BAO.",
  "authors": [
    {
      "affiliations": [
        "Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Ettore Nicolini"
    },
    {
      "affiliations": [
        "Stroke Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy"
      ],
      "name": "Antonio Ciacciarelli"
    },
    {
      "affiliations": [
        "Neurology and Stroke Unit, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy"
      ],
      "name": "Valentina Saia"
    },
    {
      "affiliations": [
        "Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy"
      ],
      "name": "Giovanni Pracucci"
    },
    {
      "affiliations": [
        "UOSD Neuroradiologia Diagnostica ed Interventistica, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy"
      ],
      "name": "Luca Milonia"
    },
    {
      "affiliations": [
        "Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Elena Barrile"
    },
    {
      "affiliations": [
        "Stroke Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy"
      ],
      "name": "Manuela De Michele"
    },
    {
      "affiliations": [
        "Neurology Unit, University Hospital Arcispedale Sant’Anna of Ferrara, Cona, Italy"
      ],
      "name": "Ilaria Casetta"
    },
    {
      "affiliations": [
        "Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Universita degli Studi di Firenze, Florence, Italy"
      ],
      "name": "Enrico Fainardi"
    },
    {
      "affiliations": [
        "Unità Di Trattamento Neurovascolare, Ospedale dei Castelli, Ariccia, Italy"
      ],
      "name": "Fabrizio Sallustio"
    },
    {
      "affiliations": [
        "SOD Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Patrizia Nencini"
    },
    {
      "affiliations": [
        "Neuroradiologia, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy"
      ],
      "name": "Stefano Vallone"
    },
    {
      "affiliations": [
        "Neurologia-Stroke Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy"
      ],
      "name": "Guido Bigliardi"
    },
    {
      "affiliations": [
        "Neuroradiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy"
      ],
      "name": "Giancarlo Salsano"
    },
    {
      "affiliations": [
        "Neurologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy"
      ],
      "name": "Tiziana Benzi Markushi"
    },
    {
      "affiliations": [
        "Neuroradiologia Interventistica, Ospedale M Bufalini di Cesena, Cesena, Italy"
      ],
      "name": "Francesca Gatti"
    },
    {
      "affiliations": [
        "UOC Neurologia e Stroke Unit, Ospedale M Bufalini di Cesena, Cesena, Italy"
      ],
      "name": "Francesco Cordici"
    },
    {
      "affiliations": [
        "Neuroradiologia, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant’Anna, Ferrara, Italy"
      ],
      "name": "Andrea Saletti"
    },
    {
      "affiliations": [
        "UO Neurologia Provinciale SS Stroke Unit Dip Neuroscienze, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant’Anna, Cona, Italy"
      ],
      "name": "Alessandro De Vito"
    },
    {
      "affiliations": [
        "Radiologia Interventistica, Azienda Ospedaliera Ospedale SS Annunziata, Taranto, Italy"
      ],
      "name": "Vittorio Semeraro"
    },
    {
      "affiliations": [
        "SC Neurologia e Stroke Unit, Azienda Ospedaliera Ospedale SS Annunziata, Taranto, Italy"
      ],
      "name": "Maria Pia Prontera"
    },
    {
      "affiliations": [
        "UO Neuroradiologia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy"
      ],
      "name": "Arianna Rustici"
    },
    {
      "affiliations": [
        "Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy"
      ],
      "name": "Andrea Zini"
    },
    {
      "affiliations": [
        "SS Interventistica Neurovascolaere, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy"
      ],
      "name": "Arianna Camilli"
    },
    {
      "affiliations": [
        "UO Neurologia d’Urgenza e Stroke Unit, IRCCS Mondino, Pavia, Italy"
      ],
      "name": "Nicola Loizzo"
    },
    {
      "affiliations": [
        "SC Neuroradiologia, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy"
      ],
      "name": "Antioco Sanna"
    },
    {
      "affiliations": [
        "Neurology and Stroke Unit, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy"
      ],
      "name": "Elena Coco"
    },
    {
      "affiliations": [
        "Neuroradiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy"
      ],
      "name": "Roberto Menozzi"
    },
    {
      "affiliations": [
        "Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy",
        "Programma Stroke Care, Dipartimento di Emergenza e Urgenza, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy"
      ],
      "name": "Alessandro Pezzini"
    },
    {
      "affiliations": [
        "Neuroradiologia, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy"
      ],
      "name": "Domenico Sergio Zimatore"
    },
    {
      "affiliations": [
        "UO Neurologia e Stroke Unit \"F. Puca”, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy"
      ],
      "name": "Marco Petruzzellis"
    },
    {
      "affiliations": [
        "UO Neuroradiologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy"
      ],
      "name": "Guido A Lazzarotti"
    },
    {
      "affiliations": [
        "Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy"
      ],
      "name": "Mirco Cosottini"
    },
    {
      "affiliations": [
        "DIpartimento di Biomedicina e Prevenzione, University of Rome Tor Vergata, Rome, Italy"
      ],
      "name": "Valerio Da Ros"
    },
    {
      "affiliations": [
        "Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"
      ],
      "name": "Marina Diomedi"
    },
    {
      "affiliations": [
        "UOC Neuroradiologia Diagnostica e Terapeutica, Azienda Ospedaliera Universitaria Senese, Siena, Italy"
      ],
      "name": "Sandra Bracco"
    },
    {
      "affiliations": [
        "UOC Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy"
      ],
      "name": "Rossana Tassi"
    },
    {
      "affiliations": [
        "SC Neuroradiologia, Dipartimento di Neuroscienze, ASST Cremona, Cremona, Italy"
      ],
      "name": "Michele Besana"
    },
    {
      "affiliations": [
        "SC Neurologia, ASST Cremona, Cremona, Italy"
      ],
      "name": "Alessia Giossi"
    },
    {
      "affiliations": [
        "Dipartimento di Neuroscienze, Università degli Studi di Torino, Turin, Italy"
      ],
      "name": "Mauro Bergui"
    },
    {
      "affiliations": [
        "Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy"
      ],
      "name": "Manuel Cappellari"
    },
    {
      "affiliations": [
        "IRCCS Neurological Institute of Southern Italy NEUROMED, Pozzilli, Italy"
      ],
      "name": "Salvatore Mangiafico"
    },
    {
      "affiliations": [
        "Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Danilo Toni"
    },
    {
      "affiliations": [],
      "name": "on behalf of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) group"
    }
  ],
  "title": "First-pass effect after acute basilar artery occlusion: a comparison of mechanical thrombectomy techniques",
  "uid": "f83f17bc-f904-57bf-9917-3ef6ea5689c2"
}