Endovascular Treatment of Vertebrobasilar Aneurysms

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 71-78 ◽  
Author(s):  
M. Leonardi ◽  
M. Pastore-Trossello ◽  
L. Simonetti ◽  
R. Agati
Keyword(s):  
Basilar Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Clinical Criteria ◽  
Vertebral Arteries ◽  
Posterior Circulation Aneurysms ◽  
Wide Neck ◽  
Vertebrobasilar Aneurysms ◽  
Indication For Treatment

In posterior circulation aneurysms, GDC endosaccular occlusion is the treatment of choice, when indicated. This report assessed anatomical, morphological and clinical criteria in the choice of vertebral or basilar artery occlusion in posterior circulation aneurysms, when CDC endosaccular treatment, with or without the “remodelling technique”, is not indicated, as in giant or wide-neck aneurysms. Over five years we observed eleven patients harboring posterior circulation aneurysms with no indication for treatment with GDC, or only vertebral occlusion. In our experience, the endovascular occlusion of a single or both vertebral arteries or basilar artery, following a detailed anatomical and clinical assessment, has proved a good, reliable treatment in large or giant vertebrobasilar aneurysms or those without a neck.

scholarly journals Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3454-3459 ◽  
Author(s):  
Volker Puetz ◽  
Andrei Khomenko ◽  
Michael D. Hill ◽  
Imanuel Dzialowski ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Ct Angiography ◽  
Basilar Artery ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Scale Scores

Background and Purpose— The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). Methods— BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2). Results— Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS <8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5). Conclusions— pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.

Abstract WP64: Perfusion Imaging Can Identify Basilar Occlusion Patients With a Favorable Response to Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Carlo W Cereda ◽  
Jeremy Heit ◽  
Giovanni Bianco ◽  
Marco Pileggi ◽  
Abid Qureshi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Basilar Artery ◽  
Perfusion Imaging ◽  
Univariate Analysis ◽  
Brain Regions ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Favorable Outcome ◽  
Cerebellar Hemisphere ◽  
Basilar Artery Occlusion

Introduction: Perfusion imaging can identify patients who respond favorably to endovascular therapy (EVT) in the anterior circulation; no data are available for the posterior circulation. We evaluated perfusion patterns, assessed with RAPID software, in a consecutive cohort of patients with basilar artery occlusion treated with EVT and assessed the association between reperfusion and favorable clinical outcome based on the perfusion profile. Hypothesis: We hypothesized that patients with limited regions of severe hypoperfusion (Tmax > 10s) would have a favorable response (mRS 0-2) to reperfusion (mTICI 2b-3) while patients with multiple critical brain regions severely hypoperfused would have poor outcome (mRS 4-6) despite reperfusion. Methods: From a multicenter cohort of perfusion imaging in posterior circulation stroke, we included patients with basilar artery occlusion and EVT. We pre-specified a Critical Area Perfusion Score (CAPS, 0 - 8 points) to identify severe hypoperfusion (Tmax >10s) in the following regions: inferior and/or superior cerebellar hemisphere (1-4 points), pons (2 points), midbrain/thalamus (2 points). We compared the outcome between reperfusers and non reperfusers based on the CAP score with univariate and multivariate analysis. Results: 38 patients met the inclusion criteria. Mean age was 63±17, 34% female, NIHSS 17±11. In patients who reperfused (n=30, 79%) 63% had favorable outcome, while no patient without reperfusion survived, p=0.003 OR=29 (95%CI 1.5-547). Ninety percent (19/21) of reperfused patients with CAPS ≤2 had a favorable outcome, while none of the 9 with reperfusion and a score >2 survived, p<0.001, OR=148 (95%CI 6.5-3,333). In univariate analysis, favorable outcome was associated with NIHSS OR=0.87 (95% CI 0.80-0.96), p=0.003, and mismatch volume OR=0.98 (95% CI 0.97-0.997) p=0.013. In the multivariate analysis, only CAPS was an independent predictor of favorable outcome. Conclusions: Patients with limited regions of severe hypoperfusion (Tmax > 10s) had a robust response to basilar artery EVT, however, all patients with multiple critical brain regions severely hypoperfused died despite successful reperfusion. Perfusion imaging profiles may help identify optimal patients for basilar EVT.

Abstract 2972: Perfusion CT in Patients with Basilar Artery Occlusion: Diagnostic and Prognostic Value in the Basilar Artery International Cooperation Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Lars P Pallesen ◽  
Volker Puetz ◽  
Johannes Gerber ◽  
Imanuel Dzialowski ◽  
Patrik Michel ◽  
...  
Keyword(s):  
International Cooperation ◽  
Basilar Artery ◽  
Mean Transit Time ◽  
Univariate Analysis ◽  
Artery Occlusion ◽  
Perfusion Ct ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Relative Reduction ◽  
Prognostic Impact

Background: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients with basilar artery occlusion (BAO). Compared with CTA-SI, perfusion CT (CTP) may provide added information. We assessed the diagnostic and prognostic impact of CTP compared with CTA-SI among patients in the Basilar Artery International Cooperation Study (BASICS) Methods: BASICS was a prospective observational registry of consecutive patients with acute symptomatic BAO. We applied pc-ASPECTS to CTA-SI and cerebral blood volume (CBV), cerebral blood flow (CBF), time-to-peak (TTP) and mean-transit-time (MTT) parameter maps in a 3-reader-consensus with readers blinded to clinical data. Hypoattenuation on CTA-SI, a relative reduction in CBV or CBF, or relative increase in MTT or TTP was rated as abnormal. Clinical outcome was measured with the modified Rankin Scale (mRS) score at 1 month. Results: Among 592 patients in the BASICS registry, 27 patients (4.6%) had CTP studies performed. Median (interquartile-range) pc-ASPECTS values on TTP/MTT, CTA-SI, CBF and CBV were 6 (5-8), 7 (5-9), 8 (6-9) and 10 (8.75-10), respectively (p<0.001). The proportion of patients with any perfusion abnormalities in the posterior circulation was highest for TTP/MTT (93%; CI 95% 74% to 99%), compared with 78% (CI 95% 57% to 91%) for both CTA-SI and CBF and 46% (CI 95% 27% to 66%) for CBV (p<0.001). At 1 month, 9 patients (33%) had a favourable outcome (mRS scores 0-3), 8 patients (30%) had an unfavourable outcome (mRS scores 4-5) and 10 patients (37%) were deceased. In univariate analysis, pc-ASPECTS scores did not correlate with outcome mRS scores for all imaging modalities (Spearman’s Rho, p>0.1 for all). All three patients (100%) with a CBV pc-ASPECTS <8 compared to 6 of 23 patients (26%) with a CBV pc-ASPECTS >8 died (p=0.03). Conclusion: CTP was performed in a minority of patients in the BASICS registry population. Perfusion disturbances in the posterior circulation were most frequent and most pronounced on TTP and MTT parameter maps. Extensive reduction of CBV, defined as a pc-ASPECTS <8, may indicate patients with a high case fatality.

scholarly journals Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

2020 ◽  
Vol 47 (4) ◽  
pp. 479-485
Author(s):  
Christopher R. Pasarikovski ◽  
Houman Khosravani ◽  
Leodante da Costa ◽  
Chinthaka Heyn ◽  
Stefano M. Priola ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Treatment Time ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Related Complication ◽  
Endovascular Thrombectomy

ABSTRACT:Background and Purpose:Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices.Methods:All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS.Results:A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270–639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome.Conclusion:EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.

scholarly journals Functional Independence following Endovascular Treatment for Basilar Artery Occlusion despite Extensive Bilateral Pontine Infarcts on Diffusion-Weighted Imaging: Refuting a Self-Fulfilling Prophecy

2016 ◽  
Vol 5 (3-4) ◽  
pp. 179-184 ◽  
Author(s):  
Diogo C. Haussen ◽  
Renato A.C. Oliveira ◽  
Vikas Patel ◽  
Raul G. Nogueira
Keyword(s):  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Treatment Decision ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Decision Algorithm ◽  
Operator Experience ◽  
Diffusion Weighted

Background and Purpose: Extensive brainstem diffusion-weighted imaging (DWI) hyperintensity has been associated with poor outcomes. We aim at documenting a series of patients with extensive DWI pontine lesions who achieved independence following endovascular therapy and aggressive medical therapy in the setting of posterior circulation basilar artery occlusion (BAO). Methods: This is a retrospective endovascular database review of a single-operator experience over a 9-year period for patients with (1) complete BAO, (2) extensive bilateral pontine DWI changes and (3) 90-day modified Rankin scale 0-2. Results: Three out of a total of 40 patients met the inclusion criteria. Case 1 was an 18-year-old male with National Institutes of Health Stroke Scale (NIHSS) 32 on admission, treated 25 h after symptom onset. Case 2 was a 56-year-old male with NIHSS 19, treated 10 h after onset. Case 3 was a 73-year-old male with NIHSS 29, treated 6 h after onset. Full endovascular reperfusion was achieved in all 3 patients. A literature review identified 9 additional cases of extensive pontine DWI changes and good outcome. These patients were young (32 ± 22 years), mostly males (69%), presented with a relatively low posterior circulation Acute Stroke Prognosis Early CT Score (6 ± 1), were treated relatively late from last known normal (13 ± 10 h) and were mostly (84%) treated with endovascular intervention. Conclusion: Extensive bilateral pontine DWI lesions among patients with BAO are not an unequivocal indicator of poor prognosis. We advise strong caution when considering these findings in the treatment decision algorithm.

Collateral flow predicts outcome after basilar artery occlusion: The posterior circulation collateral score

2016 ◽  
Vol 11 (7) ◽  
pp. 768-775 ◽  
Author(s):  
Erik JRJ van der Hoeven ◽  
Ferghal McVerry ◽  
Jan Albert Vos ◽  
Ale Algra ◽  
Volker Puetz ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Collateral Flow

Basilar Artery Occlusion

2019 ◽  
pp. 547-554
Author(s):  
Michael R. Pichler ◽  
Jennifer E. Fugate
Keyword(s):  
Blood Supply ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Therapeutic Interventions ◽  
Basilar Artery Occlusion ◽  
Improve Outcome ◽  
Posterior Circulation Stroke

Basilar artery occlusion (BAO), a type of posterior circulation stroke, refers to occlusion of the basilar artery at any point along its course. Patients with BAO can present in many ways, depending on the location of the occlusion and the collateral blood supply. Timely recognition of BAO is essential given the potential for effective therapeutic interventions shown to improve outcome.

scholarly journals Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions

Stroke ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 389-395 ◽  
Author(s):  
Tobias Boeckh-Behrens ◽  
David Pree ◽  
Nina Lummel ◽  
Benjamin Friedrich ◽  
Christian Maegerlein ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Scale Score ◽  
Basilar Artery ◽  
Odds Ratio ◽  
Artery Occlusion ◽  
Low Flow ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Flow Conditions ◽  
Vertebral Arteries

Background and Purpose— Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy. Methods— Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients’ characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3. Results— One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10–22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97–17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42–179.00). Conclusions— Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries.

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