E-093 Acute ischemic stroke from fibrocartilaginous embolism to the basilar artery

Background and purposeTo determine the initial factors, including patient characteristics, stroke etiology and severity, time factors, and imaging findings, that could affect the clinical outcome of patients with acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) where successful recanalization was achieved via mechanical thrombectomy.MethodsBetween March 2011 and December 2014, 35 patients with AIS caused by BAO received MRI/MR angiography-based mechanical thrombectomies, and recanalization was achieved with a Thrombolysis In Cerebral Infarction score of >2b. The patients were divided into a good outcome group (n=19), defined as those with a modified Rankin Scale (mRS) score of 0–2 at 3 months after stroke onset, and a poor outcome group (n=16), defined as a mRS score of 3–6. The differences between the groups were analyzed.ResultsInitial National Institutes of Health Stroke Scale (NIHSS) score (good vs poor: 17.9±8.9 vs 27.6±8.5, p=0.003), posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) based on initial diffusion-weighted images (DWI) (good vs poor: 7.8±1.6 vs 5.4±1.8, p=0.001), pc-ASPECTS based on contrast staining on the post-thrombectomy control CT (good vs poor: 9.2±1.5 vs 6.3±2.2, p<0.001), and presence of contrast staining in the brainstem on that CT (good vs poor: 15.8% vs 81.6%, p<0.001) were significantly different between the groups.ConclusionsPatients with AIS caused by BAO with a lower initial NIHSS score, fewer lesions on initial DWI, and less contrast staining on the post-thrombectomy control CT have higher probabilities of a good clinical outcome after successful recanalization via a mechanical thrombectomy.

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Intracranial Stenting as Rescue Therapy After Failure of Mechanical Thrombectomy for Basilar Artery Occlusion: Data From the ANGEL-ACT Registry

Frontiers in Neurology ◽

10.3389/fneur.2021.739213 ◽

2021 ◽

Vol 12 ◽

Author(s):

Gang Luo ◽

Feng Gao ◽

Xuelei Zhang ◽

Baixue Jia ◽

Xiaochuan Huo ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Intracranial Hemorrhage ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Rescue Therapy ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose: Studies on rescue therapy for acute posterior circulation stroke due to basilar artery occlusion (BAO) are limited in the modern era of mechanical thrombectomy (MT). The aim of this study was to evaluate the safety and efficacy of rescue stenting (RS) following MT failure in patients with BAO.Methods: Data were collected from the Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) prospective registry in China. Patients who underwent MT for BAO with failure of recanalization were enrolled in this study. The patients were divided into the RS and non-RS groups. Clinical and laboratory findings, procedural details, and clinical outcomes were compared between the two groups.Results: Overall, 93 patients with acute BAO were analyzed. The RS group included 81 (87.1%) patients, and the non-RS group included 12 patients. A modified treatment in cerebral infarction (mTICI) score of 2b/3 was achieved in 75 (92.6%) patients in the RS group. Compared with the non-RS group, the RS group had a significantly higher rate of successful recanalization and favorable clinical outcomes (modified Rankin Scale score at 90 days post-procedure, 0–3: 16.7 vs. 51.9%, respectively; P = 0.023) without an increase in the rate of symptomatic intracranial hemorrhage and a significantly lower mortality rate (58.3 vs. 18.5%, respectively; P = 0.006). Furthermore, the use of a glycoprotein IIb/IIIa inhibitor improved the rate of recanalization of the target artery without increasing the rate of symptomatic intracranial hemorrhage.Conclusions: Permanent stenting appears to be a feasible rescue modality when MT fails and might provide functional benefits in patients with acute ischemic stroke due to BAO.

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Detection of Early Ischemic Changes in Noncontrast CT Head Improved with “Stroke Windows”

ISRN Neuroscience ◽

10.1155/2014/654980 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Shraddha Mainali ◽

Mervat Wahba ◽

Lucas Elijovich

Keyword(s):

Ischemic Stroke ◽

Basal Ganglia ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Chart Review ◽

Retrospective Chart Review ◽

Image Evaluation ◽

Head Ct ◽

Noncontrast Ct ◽

Ct Head

Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P<0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%; P<0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%; P<0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows significantly improved detection of EIC.

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Nuances of transradial approach for mechanical thombectomy in acute basilar artery occlusion

Neurosurgical FOCUS ◽

10.3171/2019.1.focusvid.18420 ◽

2019 ◽

Vol 46 (Suppl_1) ◽

pp. V5 ◽

Cited By ~ 4

Author(s):

Leonardo Rangel-Castilla ◽

Giuseppe Lanzino

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Recovery Of Function ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Transradial Approach

In elderly patients with acute ischemic stroke, tortuosity of the proximal vertebral artery makes access from the transfemoral route challenging and time consuming. In such cases, a transradial approach (TA) offers a more direct vertebral artery (VA) access that overcomes proximal VA tortuosity. In this video the authors illustrate nuances of the TA for acute basilar artery occlusion in two patients with challenging proximal VA anatomy. Techniques, devices, and pitfalls are discussed. In both patients, mechanical clot retrieval was successful and resulted in significant recovery of function. The authors believe that the TA should be the initial approach for basilar artery (BA) occlusion management in elderly patients and should be considered for selected patients with other conditions requiring endovascular treatment.The video can be found here: https://youtu.be/_Ym9tMKUy_4.

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Comparison of Solitaire thrombectomy and Penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011472 ◽

2014 ◽

Vol 8 (1) ◽

pp. 13-18 ◽

Cited By ~ 25

Author(s):

Seungnam Son ◽

Dae Seob Choi ◽

Min Kyun Oh ◽

Jiho Hong ◽

Soo-Kyoung Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Aspiration Thrombectomy ◽

Scale Scores ◽

Thrombectomy Device ◽

Korean Food

Background and purposeAcute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) is a very severe neurological disease with a high mortality rate and poor clinical outcomes. In this study, we compared our experience of mechanical thrombectomy using the Solitaire stent (Solitaire thrombectomy) and manual aspiration thrombectomy using the Penumbra reperfusion catheter (Penumbra suction thrombectomy) in patients with AIS caused by BAO.Materials and methodsBetween March 2011 and December 2011, 13 patients received Solitaire thrombectomy. In January 2012, the Korean Food and Drug Administration banned the use of the Solitaire stent as a thrombectomy device, and a further 18 patients received Penumbra suction thrombectomy until December 2013. We compared parameters between patients treated with each device.ResultsSuccessful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b: 84.6% vs 100%, p=0.168) and clinical outcomes (judged by the modified Rankin Scale scores recorded at 3 months: 3.6±2.6 vs 3.2±2.6, p=0.726) were not significantly different between the two groups. However, complete recanalization rates (TICI score of 3: 23.1% vs 72.2%, p=0.015) and total procedure times (101.9±41.4 vs 62.3±34.8 min, p=0.044) were significantly higher, and shorter, respectively, in patients treated by Penumbra suction thrombectomy.ConclusionsThe two thrombectomy devices were associated with similar recanalization rates and clinical outcomes in patients with AIS caused by BAO. However, Penumbra suction thrombectomy seemed to allow more rapid and complete recanalization than Solitaire thrombectomy.

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Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2016.59.4.400 ◽

2016 ◽

Vol 59 (4) ◽

pp. 400 ◽

Cited By ~ 4

Author(s):

Taichiro Imahori ◽

Atsushi Fujita ◽

Kohkichi Hosoda ◽

Eiji Kohmura

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Trigeminal Artery ◽

Persistent Primitive Trigeminal Artery ◽

Endovascular Revascularization ◽

Primitive Trigeminal Artery

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Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011883 ◽

2015 ◽

Vol 8 (8) ◽

pp. 783-786 ◽

Cited By ~ 31

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Chris Nickele ◽

Vinodh T Doss ◽

Dan Hoit ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Basilar Artery ◽

Functional Independence ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Stroke Severity ◽

Nihss Score

IntroductionThe natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.ObjectiveTo examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.MethodsWe conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0–2 at 3 months.ResultsA total of 21 patients with AIS due to BAO (age range 31–84 years, median admission NIHSS score: 18 points, range 2–38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)).ConclusionsThe presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT.

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Direct PTA for Acute Ischemic Stroke

Interventional Neuroradiology ◽

10.1177/15910199970030s207 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 47-50 ◽

Cited By ~ 4

Author(s):

J. Uno

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Internal Carotid ◽

Fibrinolytic Therapy ◽

Extracranial Internal Carotid Artery ◽

Extracranial Vertebral Artery ◽

Extracranial Ica

We have performed direct PTA for 23 patients with acute ischemic stroke. Occlusion was identified at extracranial internal carotid artery (ICA) in 6 patients, at extracranial vertebral artery (VA) in 1, at intracranial ICA in 3, at middle cerebral artery (MCA) in 12, and at basilar artery (BA) in 1. Stenosis was identified at extracranial VA in 1 patient. In 4 of 6 patients of extracranial ICA, 1 of 1 patient of extracranial VA, 1 of 3 patients of intracranial ICA, 7 of 12 patients of MCA and 1 of 1 patient of BA, recanalization was observed. Fourteen of 22 occluded arteries (64%) were recanalized. The recanalization rate approximated that of local intraarterial fibrinolytic therapy. We have not experienced complications with this procedure. Direct PTA is promising and might be a novel recanalization technique.

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