scholarly journals Ruptured Giant Basilar Artery Aneurysm in a Comatose Adolescent: Successful Obliteration Using Intraoperative SSEP, BAER, and MEP Monitoring

2006 ◽  
Vol 12 (3) ◽  
pp. 237-244 ◽  
Author(s):  
C.I. Nwagwu ◽  
M.S. Mathews ◽  
J.A. Scott ◽  
A.J. Denardo ◽  
T.G. Horner
Keyword(s):  
Basilar Artery ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Vascular Lesions ◽  
Basilar Artery Occlusion ◽  
Honor Student ◽  
Adequate Blood Supply ◽  
Artery Flow ◽  
Neurologically Intact

Giant basilar aneurysms are infrequently seen in children. We present the endovascular management of an adolescent who presented comatose with pinpoint pupils due to a ruptured giant basilar trunk aneurysm. A noncontrast head CT disclosed a large prepontine lesion with brainstem hemorrhage. Catheter angiography showed a 4.5 cm irregular, fusiform basilar trunk aneurysm. With SSEP, BAER, and MEP monitoring, the patient underwent bilateral temporary vertebral artery occlusion, followed by GDC embolization of the aneurysm. Postprocedure internal carotid angiograms showed adequate blood supply to the basilar apex via patent posterior communicating arteries. On postprocedure day two, the patient was following commands. The remainder of his hospital course was uneventful. Postoperative angiograms showed no residual filling of the aneurysm. At 12 months the patient was neurologically intact and at baseline function as an honor student and follow-up angiogram showed persistent occlusion of the aneurysm from the circulation. Successful endovascular treatment has been considered a less invasive and safer alternative to surgical management of some complex vascular lesions. While most reports on reversing basilar artery flow have been carried out in awake patients with neurological examinations, this is not possible in a patient presenting in a comatose state. This report suggests that SSEPs, BAERs and MEP may be of use in such patients in safely carrying out basilar artery occlusion.

Abstract P478: One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Fengli Li ◽  
Hongfei Sang ◽  
Jiaxing Song ◽  
Zhangbao Guo ◽  
Shuai Liu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Conventional Treatment ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Treatment Groups ◽  
Excellent Outcome ◽  
Follow Up Study

Background and Objective: To report the results of clinical follow-up at 1 year among patients in the BASILAR registry. Design, Setting, and Participants: The BASILAR study was an investigator-initiated prospective registry, which consecutively enrolled stroke patients with acute basilar artery occlusion from 47 comprehensive stroke centers in China between January, 2014, and May, 2019. Patients were divided into conventional treatment or endovascular treatment groups according to the treatment their received. We assessed clinical outcomes 1 year after patients were enrolled in the BASILAR registry. Main Outcomes and Measures: The primary outcome was the score on the modified Rankin scale (range, 0 to 6 points, with higher scores indicating more severe disability) at 1 year assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. Secondary outcomes included categories scores of the modified Rankin scale at 1 year (0 to 1 [excellent outcome], 0 to 2 [good outcome], and 0 to 3 [favorable outcome]), and death from any cause during the 1-year period after enrollment. Results: Of the 829 patients who were enrolled in the original study, 1-year data for this extended follow-up study were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin scale favored endovascular treatment over conventional treatment (adjusted common odds ratio, 4.50; 95% confidence interval [CI], 2.81 to 7.29; P < 0.001). There were significant differences between the treatment groups in the percentage of patients who had excellent outcome, good outcome and favorable outcome. The cumulative 1-year mortality rate was 54.6% in the endovascular treatment group and 83.5% in the conventional treatment group (adjusted hazard ratio, 4.36; 95% CI, 2.69 to 7.29; P < 0.001). Conclusions and Relevance: In this extended follow-up study, the beneficial effect of endovascular treatment on functional outcome at 1 year in patients with acute basilar artery occlusion was similar to that reported at 90 days in the original study.

scholarly journals Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

2020 ◽  
Author(s):  
Juhani Ritvonen ◽  
Tiina Sairanen ◽  
Heli Silvennoinen ◽  
Pekka Virtanen ◽  
Oili Salonen ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Long Term Mortality

scholarly journals A leap forward in the endovascular management of acute basilar artery occlusion since the appearance of stent retrievers: a single-center comparative study

2017 ◽  
Vol 126 (5) ◽  
pp. 1578-1584 ◽  
Author(s):  
Robert Fahed ◽  
Federico Di Maria ◽  
Charlotte Rosso ◽  
Nader Sourour ◽  
Vincent Degos ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Endovascular Management ◽  
Anterior Circulation ◽  
The Impact

OBJECTIVEContrary to acute ischemic stroke involving the anterior circulation, no randomized trial has yet demonstrated the safety and effectiveness of endovascular management in acute basilar artery occlusion (BAO). Recently developed thrombectomy devices, such as stentrievers and aspiration systems, have helped in improving the endovascular management of acute ischemic stroke. The authors sought to assess the impact of these devices in the endovascular treatment of acute BAO.METHODSA retrospective analysis of 34 consecutive patients treated in Pitié-Salpêtrière Hospital for acute BAO was carried out. All patients had undergone an endovascular procedure. In addition to the global results in terms of safety and effectiveness (recanalization rate and 3-month clinical outcome based on the modified Rankin Scale [mRS]), the authors aimed to determine if the patients treated with the most recently developed devices (i.e., the Solitaire stentriever or the ADAPT catheter) had better angiographic and clinical outcomes than those treated with older endovascular strategies.RESULTSThe overall successful recanalization rate (thrombolysis in cerebral infarction score 2b–3) was 50% (17 of 34 patients). A good clinical outcome (mRS score 0–2 at 3-month follow-up) was achieved in 11 (32.3%) of 34 patients. The mortality rate at 3-month follow-up was 29.4% (10 of 34 patients). Patients treated with the Solitaire stentriever and the ADAPT catheter had a higher recanalization rate (12 [92.3%] of 13 patients vs 5 [23.8%] of 21 patients, p = 0.0002) and a shorter mean (± SD) procedure duration (88 ± 31 minutes vs 126 ± 58 minutes, p = 0.04) than patients treated with older devices.CONCLUSIONSThe latest devices have improved the effectiveness of mechanical thrombectomy in acute BAO. Their use in further studies may help demonstrate a benefit in the endovascular management of acute BAO.

Fusiform Basilar Artery Aneurysm in a 33-Month-Old Child

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 631-634 ◽  
Author(s):  
John R. Little ◽  
Mark V. Larkins ◽  
Hans LÜders ◽  
Joseph F. Hahn ◽  
Gerald Erenberg
Keyword(s):  
Brain Stem ◽  
Basilar Artery ◽  
Evoked Potential ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Auditory Evoked Potential ◽  
Basilar Artery Occlusion ◽  
Acute Subarachnoid Hemorrhage ◽  
Rare Lesion ◽  
Evoked Potential Monitoring

Abstract A 33-month-old girl presented with acute subarachnoid hemorrhage from a ruptured multilobulated fusiform aneurysm of the midbasilar artery. This rare lesion was treated surgically by occluding the basilar artery. Intraoperative brain stem auditory evoked potential and somatosensory evoked potential monitoring results did not change with basilar artery occlusion, suggesting that the occlusion would be tolerated. However, the amplitudes of brain stem auditory evoked potential Waves III-V to right ear stimulation were transiently reduced during left pontine retraction during the aneurysm exposure. The patient made a complete clinical recovery.

Republished: Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child

2018 ◽  
Vol 10 (7) ◽  
pp. e17-e17 ◽  
Author(s):  
D Andrew Wilkinson ◽  
Aditya S Pandey ◽  
Hugh J Garton ◽  
Luis Savastano ◽  
Julius Griauzde ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Posterior Fossa Decompression ◽  
Modified Rankin Scale ◽  
Basilar Artery Thrombosis ◽  
Artery Thrombosis

Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with vertebral artery thrombosis and cerebellar stroke requiring posterior fossa decompression. She later progressed to basilar artery thrombosis treated with mechanical thrombectomy 50 hours after clinical decline. At 3 month follow-up, the patient had a modified Rankin Scale score of 0.

Endovascular recanalization for non-acute basilar artery occlusions with progressive or recurrent ischemic symptoms: a multicenter clinical experience

2021 ◽  
pp. neurintsurg-2020-017213
Author(s):  
Feng Gao ◽  
Ju Han ◽  
Xu Guo ◽  
Xuan Sun ◽  
Ning Ma ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Type I ◽  
Success Rates ◽  
Technical Success ◽  
Endovascular Recanalization ◽  
Alternative Choice

BackgroundThere is no consensus on the optimal treatment of non-acute basilar artery occlusion (BAO), and endovascular recanalization still poses a therapeutic challenge for these patients. We report a multicenter clinical experience of endovascular recanalization for symptomatic non-acute BAO and propose an angiographic grouping to determine which patient subgroup most benefits from this treatment.MethodsForty-two patients with non-acute BAO with progressive or recurrent vertebrobasilar ischemic symptoms who underwent endovascular recanalization were retrospectively analyzed from January 2015 to December 2019. These patients were classified into three subtypes based on their occlusion length and distal collateral reconstruction on angiograms. The rates of technical success, periprocedural complications and outcome, any stroke or death within 1 month, and follow-up data were examined.ResultsThe success rate of endovascular recanalization was 76.2% (32/42). The rate of periprocedural complications was 14.3% (6/42). In the three subgroups (types I–III) the success rates of endovascular recanalization were reduced (90.0%, 71.4% and 50%, respectively, p=0.023), while the overall rates of periprocedural complications were increased (5.0%, 14.3% and 37.5%, respectively, p=0.034). Type I lesions, with short-segment occlusions and good distal BA collateral reconstruction, showed favorable responses to endovascular recanalization. The median follow-up time was 1 year (IQR 11.0–19.5 months), with any stroke or death during follow-up at a rate of 7.9%.ConclusionEndovascular recanalization can be safe and feasible for reasonably selected patients with non-acute BAO, especially type I lesions, and offers an alternative choice for those with progressive or recurrent vertebrobasilar ischemic symptoms despite aggressive medical therapy.

scholarly journals Embolectomy in Patient with Basilar Artery Occlusion and Poor Neurological Exam

2019 ◽  
pp. 1-4
Author(s):  
Hekmat Zarzour ◽  
Hekmat Zarzour ◽  
Joshua Weinberg ◽  
Michael McAree ◽  
Neal Joshi ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Basilar Artery ◽  
Functional Outcomes ◽  
Poor Prognosis ◽  
Mortality Rates ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Good Patient ◽  
Neurological Exam ◽  
Neurologically Intact

Background: Acute basilar artery occlusion (BAO) is generally associated with a poor prognosis and mortality rates up to 85% in non-recanalized patients. Emergent recanalization is essential to improve outcomes in this patient subgroup. Objective: To show that good patient outcomes, modified Rankin score (mRS) 0-2, can be achieved in patients presenting with acute BAO and poor or no neurological exam. Methods: We retrospectively analyzed the hospital course of a patient presenting with acute BAO and absent brainstem reflexes who underwent emergent revascularization. Results: The patient was discharge with cranial nerve III palsy but was otherwise neurologically intact. Conclusions: Patients presenting with acute BAO and poor or no neurological exam should be considered for emergent endovascular intervention. Despite the high risk of morbidity and mortality, this subgroup of patients can still have good functional outcomes.

Stent Retriever-Assisted Mechanical Thrombectomy for Acute Basilar Artery Occlusion: Single US Institution Experience

2015 ◽  
Vol 12 (3) ◽  
pp. 250-259 ◽  
Author(s):  
Ashish Sonig ◽  
Chandan Krishna ◽  
Sabareesh K Natarajan ◽  
Jian Liu ◽  
L Nelson Hopkins ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Scale Score ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Stent Retrievers

Abstract BACKGROUND Acute basilar artery occlusion causes devastating strokes that carry high mortality and morbidity. OBJECTIVE To report the outcomes of mechanical thrombectomy in the posterior circulation with a focus on safety and efficacy of stent retrievers. METHODS We retrospectively reviewed our endovascular database for all patients treated with stent retrievers for posterior circulation stroke between June 2012 and June 2014. Twelve patients were identified. The following data were analyzed: thrombus location, previous stroke or transient ischemic attack, thrombus etiology, comorbidities, time from presentation to initiation of endovascular treatment, time from start of angiography to revascularization, and whether intravenous tissue plasminogen activator was administered pre-thrombectomy. Outcome was considered poor when modified Rankin Scale score was &gt;2. RESULTS Mean patient age was 63.42 years (median, 64.5; range, 28-83 years); 7 were women. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 11 of 12 patients (91.7%). Mean discharge modified Rankin Scale score was 2.3 (median, 2.0; standard deviation 1.96; range, 0-6), with a favorable discharge outcome in 9 of 12 (75%) patients. Two patients died as inpatients. Mean follow-up modified Rankin Scale score was 1.4 (median, 1.00; standard deviation 1.075; range, 0-4). Good outcome was achieved in 9 of 10 (90%) patients at last follow-up (mean follow-up duration, 132.42 days [median, 90.50; standard deviation 80.2; range, 8-378 days]). CONCLUSION Our single-institution study has shown that good clinical outcomes and successful recanalization with acceptable mortality can be achieved with current stent retrievers.

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