Republished: A novel route of revascularization in basilar artery occlusion and review of the literature

2015 ◽  
Vol 8 (7) ◽  
pp. e25-e25 ◽  
Author(s):  
Alejandro Morales ◽  
Phillip Vaughan Parry ◽  
Ashutosh Jadhav ◽  
Tudor Jovin
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Antiplatelet Agents ◽  
Artery Occlusion ◽  
Direct Access ◽  
Basilar Artery Occlusion ◽  
Review Of The Literature ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Angioplasty And Stenting

Ischemia of the basilar artery is one of the most devastating types of arterial occlusive disease. Despite treatment of basilar artery occlusions (BAO) with intravenous tissue plasminogen activator, antiplatelet agents, intra-arterial therapy or a combination, fatality rates remain high. Aggressive recanalization with mechanical thrombectomy is therefore often necessary to preserve life. When direct access to the basilar trunk is not possible, exploration of chronically occluded vessels through collaterals with angioplasty and stenting creates access for manual aspiration. We describe the first report of retrograde vertebral artery (VA) revascularization using thyrocervical collaterals for anterograde mechanical aspiration of a BAO followed by stenting of the chronically occluded VA origin. Our novel retrograde–anterograde approach resulted in resolution of the patient's clinical stroke syndrome.

Republished: Basilar artery occlusion in a child treated successfully with mechanical thrombectomy using ADAPT

2016 ◽  
Vol 9 (1) ◽  
pp. e2-e2 ◽  
Author(s):  
Jonathan Lena ◽  
Ramin Eskandari ◽  
Libby Infinger ◽  
Kyle M Fargen ◽  
Alejandro Spiotta ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Pediatric Population ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
First Case ◽  
Intravenous Tissue Plasminogen Activator ◽  
First Pass ◽  
Tissue Plasminogen ◽  
Arterial Thrombolysis

Acute ischemic stroke (AIS) in the pediatric population is rare. Furthermore, it is common for physicians to take significantly longer diagnosing a posterior circulation stroke in a child than in an adult. There are increasing case reports in the literature of treating AIS in children with intravenous tissue plasminogen activator, intra-arterial thrombolysis, and/or mechanical thrombectomy. We present the first case of pediatric AIS treated using a direct aspiration first pass technique (ADAPT) as a means of mechanical thrombectomy.

Successful Intra-arterial Basilar Artery Thrombolysis in a Patient with Bilateral Vertebral Artery Occlusion: Technical Case Report

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-E398-ONS-E398 ◽  
Author(s):  
Huan Wang ◽  
Kenneth Fraser ◽  
David Wang ◽  
Jorge Alvernia ◽  
Giuseppe Lanzino
Keyword(s):  
Vertebral Artery ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Basilar Artery ◽  
Clinical Presentation ◽  
Artery Occlusion ◽  
Direct Access ◽  
Basilar Artery Occlusion ◽  
Vertebral Artery Occlusion ◽  
Tissue Plasminogen

Abstract OBJECTIVE AND IMPORTANCE: Basilar artery occlusion is a clinical event with an exceedingly high mortality rate. Improved survival is closely associated with successful recanalization of the occluded basilar artery. Bilateral vertebral artery occlusion (BVAO) is a unique disease entity that effectively denies any direct access to the basilar artery for endovascular rescue therapy. We report a case of successful intra-arterial basilar artery thrombolysis in a patient with BVAO. CLINICAL PRESENTATION: A 78-year-old man was transferred to our hospital after intravenous administration of tissue plasminogen activator and with deteriorating neurological status requiring intubation. His clinical presentation was highly suggestive of acute basilar artery thrombosis. The cerebral angiogram showed a BVAO and collateral flow reconstituting both distal extracranial vertebral arteries but with significant contrast stasis. There was no retrograde filling of the basilar artery through the only angiographically visible posterior communicating artery. TECHNIQUE: Selective catheterizations of the left occipital artery and the left ascending cervical branch of the thyrocervical trunk were performed to deliver a total of 12 mg of tissue plasminogen activator. At that point, the patient showed significant neurological improvement. The post-tissue plasminogen activator angiogram showed improved flow through the basilar artery. The patient was independent and well at his 1-year follow-up visit. CONCLUSION: Knowledge of potential collateral pathways is important when direct access to the main intracranial vessels is not available. Basilar artery thrombolysis through collateral vessels is clinically effective when a direct approach to the artery is not feasible.

Republished: Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever

2015 ◽  
Vol 8 (8) ◽  
pp. e33-e33 ◽  
Author(s):  
Luis Savastano ◽  
Joseph J Gemmete ◽  
Aditya S Pandey ◽  
Christopher Roark ◽  
Neeraj Chaudhary
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Safety Data ◽  
Artery Occlusion ◽  
Stent Retriever ◽  
Basilar Artery Occlusion ◽  
Stroke Patients ◽  
Tissue Plasminogen

Ischemic strokes in childhood are rare. Thrombolytic therapy with intravenous (IV) tissue plasminogen activator (tPA) has been the main intervention for the management of pediatric stroke patients, but safety data are lacking and efficacy has been questioned. Recently, successful endovascular treatments for acute ischemic stroke in children have been reported with increasing frequency, suggesting that mechanical thrombectomy can be a safe and effective treatment. We present the case of a 22-month-old child with acute ischemic stroke due to basilar artery occlusion that was successfully treated with a stent retriever.

Basilar Artery Occlusion Chinese Endovascular Trial: Protocol for a prospective randomized controlled study

2021 ◽  
pp. 174749302110409
Author(s):  
Chuanhui Li ◽  
Chuanjie Wu ◽  
Longfei Wu ◽  
Wenbo Zhao ◽  
Jian Chen ◽  
...  
Keyword(s):  
Sample Size ◽  
Basilar Artery ◽  
Symptom Onset ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Controlled Study ◽  
Randomized Controlled

Rationale There are no randomized trials examining the best treatment for acute basilar artery occlusion in the 6–24-hour time window. Aims To assess the safety and efficacy of thrombectomy for stroke due to basilar artery occlusion in patients randomized within 6–24 h from symptom onset or time last seen well. Sample size For an estimated difference of 20% in proportions of the primary outcome between the two groups, 318 patients will be included for 5% significance and 90% power with a planned interim analysis after two-thirds of the sample size (212 patients) have achieved the 90 days follow-up. Methods and design A prospective, multi-center, randomized, controlled, open-label and blinded-endpoint trial. The randomization employs a 1:1 ratio of mechanical thrombectomy with the detachable Solitaire thrombectomy device and best medical therapy (BMT) vs. BMT alone. Study outcomes The primary outcome will be the proportion of patients achieving modified Rankin Scale (mRS) 0–3 at 90 days. Key secondary outcomes are: dramatic early favorable response, dichotomized mRS score (0–2 vs. 3–6 and 0–4 vs. 5–6) at 90 days, ordinal (shift) mRS analysis at 90 days, infarct volume at 24 h, vessel recanalization at 24 h in both treatment arms, and successful recanalization in the thrombectomy arm according to the modified thrombolysis in cerebral infarction (mTICI) classification defined as mTICI 2 b or 3. Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage rates at 24 h, and procedure-related complications. Discussion Results from this trial will indicate whether mechanical thrombectomy is superior to medical management alone in achieving favorable outcomes in subjects with acute stroke caused by basilar artery occlusion presenting within 6–24 h from symptom onset. Trial registration: URL: http://www.clinicaltrials.gov . ClinicalTrials.gov Identifier: NCT02737189.

scholarly journals Correction to: Mechanical Thrombectomy in Basilar Artery Occlusion

2018 ◽  
Vol 29 (1) ◽  
pp. 161-162 ◽  
Author(s):  
Volker Maus ◽  
Alev Kalkan ◽  
Christoph Kabbasch ◽  
Nuran Abdullayev ◽  
Henning Stetefeld ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

Abstract 1122‐000147: Factors associated with the Delayed Door to Puncture Time for the Basilar Artery Occlusion patient

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Brandon Nguyen ◽  
Ichiro Yuki ◽  
Dana Stradling ◽  
Jordan C Xu ◽  
Kiarash Golshani ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Medical Center ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
P Value ◽  
Vessel Occlusion ◽  
Factors Associated ◽  
Delayed Initiation

Introduction : Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence‐based. In the real‐world practice, it is also often encountered that the delayed initiation of the MT happens for this particular patient groups due to lack of cortical signs and other medical confounding factors. Methods : We retrospectively analyzed the angiographical and clinical outcomes of consecutive BAO patient who underwent MT in single institution. Onset to treatment (OTT), Door to Puncture (DTP) time were compared with those in anterior circulation large vessel occlusion (ACLVO) group who underwent MT in the same time period. For those showed significantly longer DTP time, the factors associated with the delayed initiation of the MT were analyzed. Results : A total of 271 patients underwent mechanical thrombectomy at UCI Medical Center between Jan 2016 and June 2021. Of these, 32 patients diagnosed as BAO by CTA and underwent MT were included in the study. Successful recanalization was achieved in 28 cases (87.5%), and symptomatic ICH occurred in 3 cases (9.4%). Nine patients (28.1%) showed good clinical outcomes (mRS 0–3) at 3 months. The median Onset to Puncture Time (OTT) was 340 min. The median DTP time (145 min) was significantly longer as compared to the ACLVO patients (99 min) (p value = 0.04). Of the 6 patients who showed significant delay in the initiation of intervention (DTP>300 min), 5 patients (83.3%) did not have the initial “stroke‐code activation” at the time of ED arrival. The cause of the delay was due to lack of cortical sign (3), bilateral spontaneous sustained clonus, which misinterpreted as seizure (1), AMS with non‐focal neurological signs interpreted as encephalopathy (2). Conclusions : DTP of the patients who underwent MT for BAO was significantly longer than that in ACLAO. Lack of cortical sings which are markers of ACLVO were associated with delayed activation of stroke code. Establishment of BAO screening in the ED assessment and prompt activation of Stroke code may contribute to the improvement of MT treatment for the BAO patients.

Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

2021 ◽  
Keyword(s):  
General Anaesthesia ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

scholarly journals Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jin Wook Choi ◽  
Miran Han ◽  
Jung Hyun Park ◽  
Woo Sang Jung
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Treatment Method ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Procedure Time ◽  
First Line ◽  
Aspiration Thrombectomy ◽  
First Pass ◽  
First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

Sign in / Sign up

Export Citation Format

Share Document