scholarly journals Mechanical Thrombectomy for Tandem Vertebrobasilar Stroke

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1883-1885
Author(s):  
Sung Hyun Baik ◽  
Cheolkyu Jung ◽  
Byung Moon Kim ◽  
Dong Joon Kim
Keyword(s):  
Clinical Outcome ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Access Route ◽  
Procedure Time ◽  
Good Clinical Outcome ◽  
Vertebrobasilar Stroke

Background and Purpose— Tandem vertebrobasilar strokes are not well-known causes of posterior circulation stroke. The purpose of this study was to investigate the characteristics and outcome of mechanical thrombectomy in patients with tandem vertebrobasilar stroke. Methods— Acute basilar artery occlusion patients with tandem vertebral artery (VA) stenosis/occlusion who underwent mechanical thrombectomy were retrospectively analyzed. Concomitant tandem VA steno-occlusion was defined as severe stenosis/occlusion of the extracranial VA with impaired flow. Clinical/angiographic characteristics, recanalization rate, procedure time, and clinical outcome were evaluated with comparisons according to the treatment strategy. Results— Tandem vertebrobasilar occlusion was identified in 24.6% (55 of 224) of the acute basilar artery occlusion patients. Overall successful recanalization and good clinical outcome was achieved in 87.2% (48 of 55) and 30.9% (17 of 55) of the patients. There were no significant differences in procedure time, recanalization rate, and clinical outcome in comparisons of the VA access route selection or angioplasty of the tandem VA lesion. Two patients developed short-term recurrent basilar artery occlusion when angioplasty of the tandem VA lesion was not performed. Good clinical outcome was more likely with lower baseline National Institutes of Health Stroke Scale score (odds ratio, 0.87 [95% CI, 0.787–0.961]; P =0.006) and short onset-to-recanalization time (odds ratio, 0.993 [95% CI, 0.987–0.999]; P =0.03). Conclusions— Tandem vertebrobasilar occlusion may be a frequent pathological mechanism of posterior circulation stroke. Good outcome may be achieved by strategic choice of the access route and selective angioplasty of the tandem VA lesion.

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.

Initial factors affecting the clinical outcome after successful recanalization via MR-based mechanical thrombectomy in patients with acute ischemic stroke due to basilar artery occlusion

2015 ◽  
Vol 8 (9) ◽  
pp. 889-893 ◽  
Author(s):  
Seungnam Son ◽  
Yong-Won Kim ◽  
Min Kyun Oh ◽  
Soo-Kyoung Kim ◽  
Ki-Jong Park ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Nihss Score ◽  
Diffusion Weighted Images ◽  
Outcome Group

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.

Abstract WP26: Improved Clinical Outcome of Acute Basilar Artery Occlusion Since Introduction of Endovascular Thrombectomy Devices

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Peter A Ringleb ◽  
Lars Kellert ◽  
Markus Moehlenbruch ◽  
Simon Nagel ◽  
Julian Boesel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Treatment Strategies ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Good Clinical Outcome ◽  
Entire Cohort ◽  
Before And After ◽  
Common Clinical Practice

Background: Survival and functional outcome of patients with acute basilar artery occlusion (BAO) are highly dependent on vessel recanalization. Therefore intra-arterial thrombolysis is recommended in international guidelines. For several years, thrombectomy-devices are used for intra-arterial therapy. We analyzed if the use of those devices modified the outcome of patients with BAO in our institution. Method: Retrospective analysis of prospectively collected data on consecutive patients with acute BAO since 1998. In July 2009 for the first time a thrombectomy device was used in a patient with BAO. Thereafter the cohort was split into two chronological groups. All patients were treated at a dedicated neurological ICU following institutional SOPs. Functional outcome was assessed three months after treatment using the modified Rankin Scale (mRS); good clinical outcome was defined as mRS 0-2. Symptomatic intracranial hemorrhage (sICH) was defined as intracranial blood on follow-up imaging up to 36 hours after treatment associated with clinical worsening of at least 4 points of the NIHSS or leading to death. Results: From the entire cohort of N=124 patients, n=91 patients were treated before and n=33 after July 2009. A “bridging concept” (i.e. IVT + IAT) was applied in 20% vs. 64% of the patients before and after July 2009, respectively. Complete recanalization (TICI 3) was achieved in 45% before and 77% after July 2009 (p=0.005). SICH occurred in 7% of the earlier and 3% of the later cohort (p=0.67); good clinical outcome was observed in 10% of the earlier and 33% of the later cohort (p=0.004); mortality was 57% in the earlier and 30% in the later group (p=0.01). After adjustment for baseline imbalances (proportion of patients with previous stroke, time until first treatment) the differences remained significant for good clinical outcome (OR 3.86; 95%CI 1.27 - 11.7; p=0.017) and mortality (OR 0.38; 95%CI 0.15-0.99; p=0.047). Conclusion: Modern thrombectomy-devices as well as the increased use of bridging approaches for treatment of BAO have significantly improved good clinical outcome and attenuated mortality. Especially in patients with BAO - where endovascular treatment strategies are common clinical practice - those devices should be used more frequently.

scholarly journals Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome

Radiology ◽  
2019 ◽  
Vol 291 (3) ◽  
pp. 730-737 ◽  
Author(s):  
Sung Hyun Baik ◽  
Hyung Jong Park ◽  
Jun-Hwee Kim ◽  
Chang Ki Jang ◽  
Byung Moon Kim ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

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.

scholarly journals Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study

2019 ◽  
Vol 9 (2) ◽  
pp. 90-97
Author(s):  
Isabella Francalanza ◽  
Antonio Ciacciarelli ◽  
Antonio Armando Caragliano ◽  
Carmela Casella ◽  
Masina Cotroneo ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Observational Study ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Stroke Treatment ◽  
Nihss Score ◽  
Acute Stroke Treatment

Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.

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