scholarly journals Seeing Is Believing: Headway27 as a Highly Visible and Versatile Microcatheter with Ideal Dimensions for Stroke Thrombectomy

2018 ◽  
Vol 7 (6) ◽  
pp. 341-346 ◽  
Author(s):  
William J. Ares ◽  
Benjamin M. Zussman ◽  
Cynthia L. Kenmuir ◽  
Gregory M. Weiner ◽  
Habibullah Ziayee ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Basilar Artery ◽  
Posterior Circulation ◽  
Target Vessel ◽  
Aspiration Thrombectomy ◽  
Intended Target ◽  
Patient Demographics ◽  
Procedural Complications ◽  
Technical Details ◽  
Technique Evaluation

Introduction: Microcatheter selection is an infrequent focus of stroke thrombectomy technique evaluation. The Headway27 microcatheter strikes an excellent balance of microcatheter dimensions (156 cm length, 2.6 Fr distal OD, ID 0.027 inches) and visibility, making it ideal for stroke thrombectomy. Methods: We evaluated a prospectively maintained acute stroke thrombectomy database containing 50 consecutive cases using the Headway27 microcatheter. From the database, patient demographics, clinical and angiographic information as well as procedural technical details and complications were extracted. Results: Manual aspiration thrombectomy (MAT) was performed alone in 72% of cases, stentriever-assisted MAT was performed in 6% of cases, and a combination was used in 22% of cases. Median groin puncture to final recanalization time was 27 min and mTICI 2B/3 recanalization was achieved in 94% of cases. There were 2 intra-procedural complications, neither related to the microcatheter. In all cases, the Headway27 reached the intended target vessel: M1 (n = 4), M2 (n = 26), M3 (n = 13), P2 (n = 3), P3 (n = 1), and basilar artery (n = 3). There were no cases requiring usage of an additional or alternative microcatheter. In 45/47 cases of MAT, the reperfusion catheter tracked over the Headway to the clot/intended target; in two cases, the microcatheter was used to deploy a stentriever that then allowed the reperfusion catheter to track to the clot. Conclusion: The Headway27 microcatheter reliably facilitated rapid clot access in anterior and posterior circulation acute large vessel occlusions with no microcatheter-associated complications.

scholarly journals Permanent Deployment of the Solitaire FR™ Device in the Basilar Artery in an Acute Stroke Scenario

2017 ◽  
Vol 7 (1-2) ◽  
pp. 6-11
Author(s):  
Miguel S. Litao ◽  
Erez Nossek ◽  
Keith DeSousa ◽  
Albert Favate ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Basilar Artery ◽  
Effective Means ◽  
Posterior Circulation ◽  
National Institutes Of Health ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Vessel Patency ◽  
Solitaire Fr

Background: Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. Summary: We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. Key Messages: Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.

Abstract WMP4: Predictors of Functional Recovery After Thrombectomy in Posterior Circulation Stroke - Insights From the STAR Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ali M Alawieh ◽  
Maya Eid ◽  
Mohammad Anadani ◽  
Mithun Sattur ◽  
Reda Chalhoub ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Basilar Artery ◽  
Functional Outcomes ◽  
Posterior Circulation ◽  
Stent Retriever ◽  
Basilar Artery Occlusion ◽  
Combined Approach ◽  
Anterior Circulation ◽  
Aspiration Thrombectomy ◽  
Posterior Circulation Stroke

Introduction: Endovascular thrombectomy (ET) for treating acute stroke in the real-world has expanded beyond the selection criteria used in major trials, and currently includes posterior circulation strokes. Posterior circulation stroke is believed to have worse outcomes than anterior circulation stroke, and its outcomes following ET are still being studied. We explored the major determinants of functional recovery after ET for posterior circulation stroke in a large cohort of patients from the Stroke Thrombectomy and Aneurysm Registry (STAR). Methods: STAR includes patients undergoing ET for acute ischemic stroke at 12 comprehensive stroke centers in the US and globally. Data on patient demographics, technical and clinical outcomes was reviewed retrospectively from patient charts and procedure notes. Primary outcomes was the modified Ranking Score (mRS) at 90 days dichotomized into favorable (mRS 0-2) and poor outcome (mRS 3-6). Results: A total of 3850 patients were reviewed, of which 345 patients (mean age 60±14) were treated for posterior circulation stroke with predominantly basilar artery occlusion (80%). Patients were treated using aspiration thrombectomy (ADAPT, 39%), stent retriever thrombectomy (31%), combined approach (19%) or intracranial stenting (7%). The overall rate of favorable outcome was 33%. Patients with diabetes, high NIHSS on admission, and proximal occlusions had significantly higher odds of poor functional outcomes on multivariate analysis (p<0.05). Compared to ADAPT thrombectomy, significantly higher odds for poor outcomes were observed with the use of stent retriever (aOR=0.84, p<0.01) or primary combined approach (aOR=2.85, p=0.05). The advantage of ADAPT on functional recovery compared to stent retrievers persisted when regression models were limited to patients with successful recanalization, or with basilar artery occlusions. No differences in complication and hemorrhage rates were observed. Conclusions: Despite similar rates of functional recovery after ET for anterior circulation stroke between stent retriever and ADAPT, our analysis demonstrates that in posterior circulation stroke, ADAPT may lead to better functional outcomes compared to stent retriever without differences in safety profiles.

CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study

2016 ◽  
Vol 12 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Lars P Pallesen ◽  
Andrei Khomenko ◽  
Imanuel Dzialowski ◽  
Jessica Barlinn ◽  
Kristian Barlinn ◽  
...  
Keyword(s):  
Acute Stroke ◽  
International Cooperation ◽  
Ct Angiography ◽  
Basilar Artery ◽  
Fatal Outcome ◽  
Artery Occlusion ◽  
Favourable Outcome ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Risk Ratios

Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. <8) and Pons-Midbrain Index (<3 vs. ≥3) with mortality and favourable outcome (modified Rankin Scale score 0–3) at one month. Results Of 619 patients in the Basilar Artery International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56–3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24–0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46–0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39–3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46–1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

Abstract WP53: The prognostic value of Posterior Circulation Acute Stroke Prognosis Early Ct Score (pcaspects) on CT perfusion in patients with basilar artery occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fana Alemseged ◽  
Darshan G Shah ◽  
Marina Diomedi ◽  
Andrew Bivard ◽  
Gagan Sharma ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcome ◽  
Acute Stroke ◽  
Basilar Artery ◽  
Prognostic Value ◽  
Ct Perfusion ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Clinical Severity ◽  
Basilar Artery Occlusion

Background: CT perfusion (CTP) increases diagnostic confidence in ischaemic stroke. Despite bone-related artefacts, CTP has been shown to improve diagnostic sensitivity compared to non contrast-CT (NCCT) and Computed Tomography Angiography source images (CTA-SI) in posterior circulation strokes. The posterior circulation Acute Stroke Prognosis Early CT score (pcASPECTS) on CTA-SI predicts clinical outcome in patients with basilar artery occlusion (BAO). We assessed the prognostic value of pcASPECTS on CTP in BAO patients. Methods: A retrospective analysis of consecutive patients with BAO diagnosed on CT angiography was performed. pcASPECTS was assessed as evident hypoattenuation on CTA-SI, focally reduced cerebral blood flow (CBF) or cerebral blood volume (CBV), focally increased time to peak of the residue function (Tmax) or mean transit time (MTT). Two investigators independently reviewed the images blinded to clinical outcome. Reliability was assessed with intraclass correlation coefficient (ICC). Good outcome was defined as modified Rankin Scale≤3 at 3 months. Results: We included 43 BAO patients with whole-brain CTP images. In receiver-operating-characteristic (ROC) analysis, the area-under-curve (AUC) was 0.79 (95% CI 0.6-0.9) for pcASPECTS on CBF, 0.77 (95% CI 0.6-0.9) on Tmax, 0.73 (95% CI 0.6-0.9) on MTT, 0.72 (95% CI 0.6-0.9) on CBV, 0.67 (95% CI 0.5-0.8) on CTA-SI. In logistic regression adjusted for age and clinical severity, pcASPECTS<8 was associated with poor outcome on Tmax (OR 14.6, 95% CI 2.3-115; p=0.007) and CBF (OR 15.1, 95% CI 1.3-121; p=0.02). Although CTP AUC did not show higher accuracy in comparison with CTA-SI AUC (p=0.2), in logistic regression, CTA-SI pcASPECTS was not significantly associated with clinical outcome (OR 6.9, 95% CI 0.7-70; p=0.1, adjusted for age, NHSS). Higher pcASPECTS on CBF (OR 0.5 95%CI 0.2-0.9, p=0.04) and Tmax (OR 0.5 95% 0.3-0.9; p=0.02) were associated with lower mortality. Interrater reliability was good for CTP maps (ICC between 0.74 and 0.86 95% CI 0.6-0.9 versus 0.66 for CTA-SI 95% CI 0.4-0.8). Conclusions: The CTP pcASPECTS may identify BAO patients at higher risk of disability and mortality.

scholarly journals Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion

Stroke ◽  
2021 ◽  
Author(s):  
Hongfei Sang ◽  
Fengli Li ◽  
Junjie Yuan ◽  
Shuai Liu ◽  
Weidong Luo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Basilar Artery ◽  
Group Versus ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Adjusted Relative Risk ◽  
Efficacy And Safety ◽  
The Impact

Background and Purpose: This study aimed to analyze the impact of baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) on the efficacy and safety of endovascular therapy (EVT) for patients with acute basilar artery occlusion. Methods: The BASILAR was a nationwide prospective registry of consecutive patients with a symptomatic and radiologically confirmed acute basilar artery occlusion within 24 hours of symptom onset. We estimated the effect of standard medical therapy alone (SMT group) versus SMT plus EVT (EVT group) for patients with documented pc-ASPECTS on noncontrast CT, both as a categorical (0–4 versus 5–7 versus 8–10) and as a continuous variable. The primary outcomes included favorable functional outcomes (modified Rankin Scale ≤3) at 90 days and mortality within 90 days. Results: In total, 823 cases were included: 468 with pc-ASPECTS 8 to 10 (SMT: 71; EVT: 397), 317 with pc-ASPECTS 5 to 7 (SMT: 85; EVT: 232), and 38 with pc-ASPECTS 0 to 4 (SMT: 13; EVT: 25). EVT was associated with higher rate of favorable outcomes (adjusted relative risk with 95% CI, 4.35 [1.30–14.48] and 3.20 [1.68–6.09]; respectively) and lower mortality (60.8% versus 77.6%, P =0.005 and 35.0% versus 66.2%, P< 0.001; respectively) than SMT in the pc-ASPECTS 5 to 7 and 8 to 10 subgroups. Continuous benefit curves also showed the superior efficacy and safety of EVT over SMT in patients with pc-ASPECTS ≥5. Furthermore, the prognostic effect of onset to puncture time on favorable outcome with EVT was not significant after adjustment for pc-ASPECTS (adjusted odds ratio, 0.98 [95% CI, 0.94–1.02]). Conclusions: Patients of basilar artery occlusion with pc-ASPECTS ≥5 could benefit from EVT. The baseline pc-ASPECTS appears more important for decision making and predicting prognosis than time to EVT. REGISTRATION: URL: http://www.chictr.org.cn . Unique identifier: ChiCTR1800014759.

Novel Diffusion-Weighted Imaging Score Showed Good Prognostic Value for Acute Basilar Artery Occlusion Following Endovascular Treatment: The Pons-Midbrain and Thalamus Score

Stroke ◽  
2021 ◽  
Author(s):  
Lian Liu ◽  
Meiping Wang ◽  
Yiming Deng ◽  
Gang Luo ◽  
Xuan Sun ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Brain Stem ◽  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Good Outcome ◽  
Diffusion Weighted

Background and Purpose: Prognostic factors for outcome of endovascular treatment remains to be investigated in patients with acute basilar artery occlusion. We aimed to assess the prognostic value of a novel pretreatment diffusion-weighted imaging score: The Pons-Midbrain and Thalamus (PMT) score. Methods: Eligible patients who underwent endovascular treatment due to acute basilar artery occlusion were reviewed. The PMT score was a diffusion-weighted imaging–based semiquantitative scale in which the infarctions of pons, midbrain, and thalamus were fully considered. The PMT score was assessed as well as the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score and Brain Stem Score. Good outcomes were defined as a modified Rankin Scale score of ≤3 at 90-day and successful reperfusion as Thrombolysis in Cerebral Infarction grades 2b/3. The associations between baseline clinical parameters and good outcomes were evaluated with logistic regression. Results: A total of 107 patients with pretreatment magnetic resonance imaging were included in this cohort. The baseline PMT score (median [interquartile range], 3 [1–5] versus 7 [5–9]; P <0.001) and Brain Stem Score (median [interquartile range], 2 [1–4] versus 3 [2–5]; P =0.001) were significantly lower in good outcome group; the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was higher in good outcome group without statistical significance. As a result of receiver operating characteristic curve analyses, the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score showed poor prognostic accuracy for good outcome (area under the curve, 0.60 [95% CI, 0.49–0.71]; P =0.081); The baseline PMT score showed significantly better prognostic accuracy for 90-day good outcome than the Brain Stem Score and National Institutes of Health Stroke Scale (area under the curve, 0.80 versus 0.68 versus 0.78, P =0.003). In addition, favorable PMT score <7 (odds ratio, 22.0 [95% CI, 6.0–80.8], P <0.001), Brain Stem Score <3 (odds ratio, 4.65 [95% CI, 2.05–10.55], P <0.001) and baseline National Institutes of Health Stroke Scale <23 (odds ratio, 8.0 [95% CI, 2.5–25.6], P <0.001) were associated with improved good outcome. Conclusions: In patients with acute basilar artery occlusion following endovascular treatment, the pretreatment diffusion-weighted imaging based PMT score showed good prognostic value for clinical outcome.

Bridging versus direct endovascular therapy in basilar artery occlusion

2021 ◽  
pp. jnnp-2020-325328
Author(s):  
Sergio Nappini ◽  
Francesco Arba ◽  
Giovanni Pracucci ◽  
Valentina Saia ◽  
Danilo Caimano ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Lower Mortality ◽  
Basilar Artery Occlusion ◽  
Bridging Therapy ◽  
Procedural Complications

BackgroundWe evaluated safety and efficacy of intravenous recombinant tissue Plasminogen Activator plus endovascular (bridging) therapy compared with direct endovascular therapy in patients with ischaemic stroke due to basilar artery occlusion (BAO).MethodsFrom a national prospective registry of endovascular therapy in acute ischaemic stroke, we selected patients with BAO. We compared bridging and direct endovascular therapy evaluating vessel recanalisation, haemorrhagic transformation at 24–36 hours; procedural complications; and functional outcome at 3 months according to the modified Rankin Scale. We ran logistic and ordinal regression models adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS), onset-to-groin-puncture time.ResultsWe included 464 patients, mean(±SD) age 67.7 (±13.3) years, 279 (63%) males, median (IQR) NIHSS=18 (10–30); 166 (35%) received bridging and 298 (65%) direct endovascular therapy. Recanalisation rates and symptomatic intracerebral haemorrhage were similar in both groups (83% and 3%, respectively), whereas distal embolisation was more frequent in patients treated with direct endovascular therapy (9% vs 3%; p=0.009). In the whole population, there was no difference between bridging and direct endovascular therapy regarding functional outcome at 3 months (OR=0.79; 95% CI=0.55 to 1.13). However, in patients with onset-to-groin-puncture time ≤6 hours, bridging therapy was associated with lower mortality (OR=0.53; 95% CI=0.30 to 0.97) and a shift towards better functional outcome in ordinal analysis (OR=0.65; 95% CI=0.42 to 0.98).ConclusionsIn ischaemic stroke due to BAO, when endovascular therapy is initiated within 6 hours from symptoms onset, bridging therapy resulted in lower mortality and better functional outcome compared with direct endovascular therapy.

149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Daga ◽  
M T Ahmad ◽  
M Taneja
Keyword(s):  
Treatment Option ◽  
Current Literature ◽  
Basilar Artery ◽  
Cerebral Angiography ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Acute Setting ◽  
Post Procedure ◽  
Basilar Artery Stenosis

Abstract The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.

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