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.

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.

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.

scholarly journals Roadmap Guided Direct Percutaneous Vertebral Artery Puncture for Mechanical Thrombectomy of Acute Basilar Artery Occlusion: A Technical Case Report and Review of the Literature

2022 ◽  
Vol 12 ◽  
Author(s):  
Jawed Nawabi ◽  
Georg Bohner ◽  
Eberhard Siebert
Keyword(s):  
Vertebral Artery ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Target Vessel ◽  
Anterior Circulation ◽  
Direct Puncture ◽  
Safety Issues

Access techniques for mechanical thrombectomy normally include percutaneous puncture of the common femoral or, more recently, the radial artery. Although target vessel catheterization may frequently not be devoid of difficulties via both routes, the vast majority of mechanical thrombectomy (MT) cases can be successfully managed. However, in a significant minority of cases, a stable target vessel access cannot be reached resulting in futile recanalization procedures and detrimental outcomes for the patients. As such, in analogy to direct carotid puncture for anterior circulation MT, direct vertebral artery (VA) puncture (DVP) is a direct cervical approach, which can constitute the only feasible access to the posterior circulation in highly selected cases. So far, due to the rarity of DVP, only anecdotal evidence from isolated case reports is available and this approach raises concerns with regard to safety issues, feasibility, and technical realization. We present a case in which bail-out access to the posterior circulation was successfully obtained through a roadmap-guided lateral direct puncture of the V2 segment of the cervical VA and give an overview of technical nuances of published DVP approaches for posterior circulation MT.

Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke

2019 ◽  
Vol 12 (5) ◽  
pp. 477-482
Author(s):  
Sung Hyun Baik ◽  
Joon Whi Kim ◽  
Byung Moon Kim ◽  
Dong Joon Kim
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Side Wall ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Procedure Time ◽  
First Pass Effect ◽  
First Pass ◽  
Number Of Passes ◽  
The Relationship

IntroductionThe relationship between the occlusive clot morphology and the efficacy of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) is not well known. Our aim was to evaluate the clinical significance of the clot meniscus sign in patients with acute BAO.Methods89 patients with acute BAO who underwent MT were retrospectively analyzed. The clot meniscus sign was defined as meniscoid/tram-track like antegrade side-wall contrast opacification of the thrombus. Patients were assigned to two groups based on the presence of the clot meniscus sign. The treatment and clinical outcomes were compared.ResultsThe clot meniscus sign was diagnosed in 62.9% (53/89) of the patients. The meniscus sign (+) group showed a shorter procedure time (55 vs 85 min; p=0.045), higher rate of successful recanalization (89.3% vs 63.6%, p=0.004), higher incidence of first pass effect (32.1% vs 6.1%, p=0.004), and lower number of passes (2 vs 3; p=0.042) when compared with the meniscus sign (−) group. The procedure time (OR 0.972, 95% CI 0.962 to 0.992; p=0.003) and clot meniscus sign (OR 7.920, 95% CI 1.769 to 35.452; p=0.007) were independent predictors of successful recanalization.ConclusionThe clot meniscus sign is related to high first pass effect and short procedure time and is a reliable predictor of successful recanalization in patients with acute BAO.

Emergent mechanical thrombectomy for acute stroke using the Mindframe Capture LP system: initial single-center experience

2015 ◽  
Vol 8 (11) ◽  
pp. 1178-1180 ◽  
Author(s):  
Russell Cerejo ◽  
Seby John ◽  
Andrew Bauer ◽  
Muhammad S Hussain ◽  
Mark Bain ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Cerebral Arteries ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Vessel Diameter ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracerebral Hemorrhage

BackgroundMechanical thrombectomy using stentrievers is the standard of care for emergent large vessel occlusion stroke. Data on the use of stentrievers in smaller caliber vessels are sparse.ObjectiveTo present our initial experience with the Mindframe Capture LP device, which was designed for mechanical thrombectomy in small cerebral arteries.MethodsA retrospective chart review was conducted of patients who underwent Mindframe device assisted emergent thrombectomy. Clinical, imaging, procedural and early follow-up data were obtained.ResultsNine patients met inclusion criteria (5 men, median age 62 years). Median National Institute of Health Stroke Scale (NIHSS) score was 18 (IQR 9–22), and 6 patients received intravenous tissue plasminogen activator. Six patients had M2 segment occlusions, and 2 patients had distal M1 segment occlusions of the middle cerebral artery. One had distal basilar artery occlusion. Median vessel diameter at the thrombus was 1.7 mm (IQR 1.5–2.5). In all 9 patients the Mindframe device was used together with manual aspiration, with median groin puncture to recanalization time of 35 min (IQR 27–54), and median procedural time of 67 min (IQR 51–91). Final Thrombolysis in Cerebral Infarction score was 3 and 2b in 4 patients each (89% total), and 2a in 1 patient. No patient had any postprocedural complications or symptomatic intracerebral hemorrhage. Median postprocedure and discharge NIHSS were 4 and 1, respectively.ConclusionsOur data suggest that the Mindframe device is safe and effective for rapid treatment of acute strokes involving small caliber intracranial vessels. Further study in a larger cohort is warranted.

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.

scholarly journals Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome

2021 ◽  
Vol 12 ◽  
pp. 445
Author(s):  
Akinari Yamano ◽  
Yasunobu Nakai ◽  
Kazuki Akutagawa ◽  
Haruki Igarashi ◽  
Kazuaki Tsukada ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Mechanical Thrombectomy ◽  
Recurrent Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Tissue Plasminogen ◽  
The Right ◽  
Cerebral Artery Occlusion

Background: Vertebral artery stump syndrome (VASS) develops into recurrent posterior circulation ischemic stroke after ipsilateral vertebral artery (VA) occlusion at its origin. Case Description: The patient was a 46-year-old man with the right posterior cerebral artery occlusion. We used a recombinant tissue plasminogen activator (rt-PA) and then performed mechanical thrombectomy using a stent retriever. Angiography revealed left VA occlusion and stagnant flow to the left VA from the right deep cervical artery; therefore, we diagnosed VASS. Within 24 h of the rt-PA injection, the symptoms had dramatically improved, and so we avoided additional antithrombotic agents. Only 13 h later, the patient developed a basilar artery occlusion and died in spite of a repeated mechanical thrombectomy. Conclusion: Vigilance against early (and sometimes fatal) recurrent stroke induced by VASS is required.

Thrombolytic Treatment of Acute Cerebral Infarction

CNS Spectrums ◽  
2005 ◽  
Vol 10 (7) ◽  
pp. 539-549 ◽  
Author(s):  
Kathleen M. Burger ◽  
Deborah R. Horowitz
Keyword(s):  
Case Reports ◽  
Optimal Management ◽  
Thrombolytic Treatment ◽  
Acute Stroke Patient ◽  
Acute Therapy ◽  
Common Cause ◽  
Intravenous Tissue Plasminogen Activator ◽  
The World ◽  
Tissue Plasminogen ◽  
Improved Outcome

AbstractStroke is a common cause of death and disability throughout the world. Acute neurologic deficits due to ischemic injury deserve rapid recognition and diagnosis in order to provide effective therapy. Intravenous tissue plasminogen activator (t-PA) provided to carefully selected patients that can be treated within 3 hours of stroke onset results in improved outcome in these patients. Intra-arterial administration of t-PA within a 6-hour window is performed at several academic centers in patients with middle cerebral and other intracranial artery occlusions based on results of one randomized clinical trial and numerous case reports. Although acute therapy of ischemic stroke has received much attention since the approval of intravenous t-PA, only a small percentage of individuals suffering a stroke actually receive t-PA. This article will review the optimal management of the acute stroke patient and discuss thrombolytic clinical trials that have been completed as well as those that are in progress.

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