Terapia fibrinolitica intra-arteriosa in occlusione vertebrobasilare acuta

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 207-210
Author(s):  
S. Mangiafico ◽  
G. Villa ◽  
G.P. Giordano ◽  
V. Scardigli ◽  
C. Pandolfo ◽  
...  
Keyword(s):  
Brain Stem ◽  
Clinical Signs ◽  
Fibrinolytic Therapy ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Basilar Artery Occlusion ◽  
Cerebral Stroke ◽  
Clinical Onset ◽  
Vertebrobasilar Stroke ◽  
Basilar Occlusion

Intra-arterial fibrinolytic therapy in acute vertebrobasilar occlusion is effective in saving the patient's life in 75% of cases if performed within 6 hours after the beginning of an ischemic event, without CT evidence of hypodense focal areas in the brain stem, cerebellum or thalamic nucleus. The initial clinical aspect of vertebrobasilar stroke is more often evolving. Only in 1/3 of cases is coma present at the beginning. In vertebro-basilar occlusion prognosis is determined by clinical and neuroradiological aspects. The outcome depends mainly upon how much brain stem function is lost during the reperfusion time, and the kind of vertebrobasilar occlusion. The case we present concerns a 38 year old man with acute onset of cerebral stroke without initial clinical signs of vertebrobasilar localization due to a basilar artery occlusion distal to AICA. Urokinase infusion was performed within three hours from the clinical onset up to a total amount of 1.400.000 UI. Reperfusion was observed one hour after the beginning of the intravascular therapy. The clinical course was favorable with good recovery (moderate superior right paresis, controlateral light cerebellar syndrome).

Basilar artery embolism

Neurology ◽  
1997 ◽  
Vol 49 (5) ◽  
pp. 1346-1352 ◽  
Author(s):  
Stefan Schwarz ◽  
Thomas Egelhof ◽  
Stefan Schwab ◽  
Werner Hacke
Keyword(s):  
Basilar Artery ◽  
Clinical Symptoms ◽  
Posterior Cerebral Artery ◽  
Clinical Signs ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Spine Trauma ◽  
Artery Embolism ◽  
Basilar Occlusion ◽  
Gcs Score

The objective of this study was to clarify the clinical and radiologic features, risk factors, and prognosis of basilar embolism without permanent basilar artery occlusion. Forty-five patients (mean age, 59 years) with basilar artery embolism participated in the study. Patients with basilar artery occlusion were excluded. The Glasgow Coma Scale (GCS) score on admission was <7 in five patients, 7 to 12 in 11 patients, and >12 in 29 patients. Etiologic factors were cardiac arrhythmia (17 patients), vertebral artery occlusion (12 patients), cervical spine trauma (4 patients), embolism following angiography (2 patients), and surgery (1 patient). MRI was performed in 17 patients and CT in 39 patients. Radiologic examinations were initially normal in 14 patients and remained normal in three patients. Final infarct localization was the thalamus (36 patients), cerebellum (20 patients), posterior cerebral artery territory (21 patients), midbrain (12 patients), and pons (8 patients). Eight to 12 weeks after stroke 12 patients were without clinical signs (Glasgow Outcome Scale [GOS] 1), 15 patients had minor neurologic deficits (GOS 2), 10 were severely disabled (GOS 3), and eight patients had died (GOS 5). Outcome correlated with GCS on admission(p < 0.0001) and with the number of ischemic lesions(p = 0.0001). The typical syndrome is an acute loss of consciousness followed by multiple brainstem symptoms. Usually, clinical symptoms improve rapidly and, in some patients, completely. Compared with basilar occlusion, basilar embolism has a relatively low mortality and outcome is frequently excellent.

scholarly journals Acute Basilar Artery Occlusion Presenting With Convulsive Movements: A Systematic Review

2022 ◽  
Vol 12 ◽  
Author(s):  
Dan Zhang ◽  
Yigang Chen ◽  
Yonggang Hao ◽  
Xingyue Hu ◽  
Xudong He
Keyword(s):  
Basilar Artery ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Basilar Artery Occlusion ◽  
Institutional Review ◽  
Initial Symptoms ◽  
Convulsive Seizures ◽  
The Right ◽  
Vessel Dissection

Background and Purpose: Convulsive seizures related to posterior circulation stroke are considered rare. However, some patients with acute basilar artery occlusion (BAO) can present with convulsive movements. Misdiagnosed as seizures may delay the reperfusion therapy for acute BAO. In this study, we have summarized the clinical features and possible mechanisms of BAO presenting with convulsive movements.Methods: We performed an Institutional Review Board-approved institutional database query from 2015 to 2020 and a literature search of the online database PubMed. Clinical data were collected and analyzed.Results: In total, 14 patients with acute BAO presented with convulsions. There were 10 men and 4 women, with a mean age of 53 (range, 23–77) years. All of these patients had different degrees of impaired consciousness (100.0%, 14/14). Convulsive movements were the initial symptoms in 78.6% (11/14) of patients. Further, 64.3% (9/14) of patients presented with paralysis or cranial nerve abnormalities, and 85.7% (12/14) of patients were treated with reperfusion therapy (thrombolysis, 35.7% [5/14]; endovascular thrombectomy, 64.3% [9/14]). The BAO etiology and mechanism were related to embolism, vessel dissections, and severe stenosis of the right vertebral artery in 57.1% (8/14), 21.4% (3/14), and 7.1% (1/14) of patients, respectively; they were undefined in 14.3% (2/14) of patients. Moreover, 42.9% (6/14) of patients had a 90-day modified Rankin Scale score of 0–2, and the mortality rate was 21.4% (3/14).Conclusions: Acute BAO, especially that related to embolism or vessel dissection, may present with convulsive movements. Acute BAO is a devastating, but treatable disease if diagnosed in time. Considering the possibility of BAO is important when dealing with patients presenting with acute-onset convulsive movements. Prompt diagnosis and reperfusion therapy may help achieve a better prognosis.

scholarly journals Endovascular management of basilar artery occlusion secondary to fusiform aneurysm with intraluminal thrombus

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V2
Author(s):  
André Beer-Furlan ◽  
Hormuzdiyar H. Dasenbrock ◽  
Krishna C. Joshi ◽  
Michael Chen
Keyword(s):  
Basilar Artery ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
High Morbidity ◽  
Large Artery ◽  
Fusiform Aneurysm ◽  
Intraluminal Thrombus ◽  
Artery Disease ◽  
Basilar Occlusion

Acute basilar artery occlusion is one of the most devastating subtypes of ischemic stroke with an extremely high morbidity and mortality rate. The most common causes include embolism, large-artery atherosclerosis, penetrating small-artery disease, and arterial dissection. The heart and vertebral arteries are the main source of emboli in embolic basilar occlusions. The authors present an uncommon acute basilar occlusion secondary to a fusiform aneurysm with intraluminal thrombus. The patient underwent a mechanical thrombectomy with successful recanalization, but persistent intraluminal thrombus. The authors discuss the management dilemma and describe their choice for placement of flow diverter stents.The video can be found here: https://youtu.be/XzBdgxJPSWQ.

Reperfusion Therapy for Acute Vertebrobasilar Occlusion

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 69-74
Author(s):  
H. Ohta ◽  
S. Nakano ◽  
T. Yano ◽  
T. Ohnishi ◽  
D. Miyahara ◽  
...  
Keyword(s):  
Brain Stem ◽  
Clinical Improvement ◽  
Photon Emission ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
The Other ◽  
Basilar Artery Occlusion ◽  
Deep Coma ◽  
Decerebrate Rigidity ◽  
The Brain

We reviewed retrospectively our experience in treating 10 patients with acute vertebrobasilar occlusion. Nine patients were treated with interventional reperfusion therapy and the remaining one patient with top of the basilar embolism was treated conservatively because of deep coma and decerebrate rigidity with severely reduced cerebral blood flow (CBF) in the brain stem. Among 9 patients with reperfusion therapy, 8 patients underwent intra-arterial thrombolytic therapy and the other one patient had direct percutaneous transluminal angioplasty (PTA). Eight patients had basilar artery occlusion, 1 patient treated with direct PTA had bilateral intracranial vertebral artery occlusion and the other patient had left posterior cerebral artery occlusion presumably preceding top of the basilar embolism. In 4 of 10 patients, residual CBF was evaluated by single photon emission computed tomograpy (SPECT). Successful recanalization with clinical improvement was achieved in 6 of 9 patients (66.7%) treated with reperfusion therapy. In patients with progression or fluctuation of incomplete brain stem syndrome, SPECT revealed preserved residual CBF and successful recanalization with clinical improvement was achieved by interventional reperfusion therapy. On the other hand, in patients with persistent deep coma and decerebrate rigidity, SPECT revealed marked reduction of residual CBF in the brain stem and recanalization could not improve clinical outcome. Preoperative SPECT may be useful to make a decision whether reperfusion therapy should be performed or not in case of vertebrobasilar occlusion.

Association of pretreatment pontine infarction with extremely poor outcome after endovascular thrombectomy in acute basilar artery occlusion

2020 ◽  
pp. neurintsurg-2020-015930
Author(s):  
Woong Yoon ◽  
Byung Hyun Baek ◽  
Yun Young Lee ◽  
Seul Kee Kim ◽  
Joon-Tae Kim ◽  
...  
Keyword(s):  
Brain Stem ◽  
Basilar Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Infarct Core ◽  
Endovascular Thrombectomy ◽  
Poor Outcome ◽  
Pontine Infarction ◽  
Pontine Infarct

BackgroundThe association between pretreatment brain stem infarction and thrombectomy outcomes remains to be elucidated in patients with acute basilar artery occlusion (BAO). We aimed to assess the association between pretreatment pontine infarction and extremely poor outcome in patients who underwent endovascular thrombectomy due to acute BAO.MethodsWe retrospectively reviewed data from a stroke database to identify patients with acute BAO who underwent thrombectomy between January 2011 and August 2019. Patient characteristics, pretreatment diffusion-weighted imaging (DWI) data, and outcomes were evaluated. The largest infarct core was expressed as the percentage of infarct core area in each brain stem region on the DWI slice displaying the largest lesion. Extremely poor outcome was defined as a 90-day modified Rankin Scale score of 5 or 6.ResultsA total of 113 patients were included, 37 of whom had extremely poor outcome. Among the 15 patients with extensive pontine infarction (largest pontine infarct core of ≥70%), 93.3% had extremely poor outcome. Multivariate logistic regression analysis revealed that the following variables were independent predictors of extremely poor outcome: extensive pontine infarction (adjusted OR 22.494; 95% CI 2.335 to 216.689; p=0.007), posterior circulation ASPECTS on DWI (adjusted OR per 1-point decrease 1.744; 95% CI 1.197 to 2.541; p=0.004), age (adjusted OR per 1-year increase 1.067; 95% CI 1.009 to 1.128; p=0.023), and baseline NIHSS (adjusted OR per 1-point increase 1.105; 95% CI 1.004 to 1.216; p=0.040).ConclusionOur results showed that a large pontine infarct core of ≥70% on pretreatment DWI was strongly associated with extremely poor outcome among patients treated with endovascular thrombectomy for 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.

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 Repeated Intravenous Thrombolysis in Patients with Recurrent Ischemic Stroke in the Vertebrobasilar Territory

2021 ◽  
pp. 510-514
Author(s):  
David Černík ◽  
Dušan Ospalík ◽  
Daniel Šaňák ◽  
Filip Cihlář
Keyword(s):  
Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Vertebrobasilar Stroke ◽  
Therapeutic Time Window

Acute ischemic vertebrobasilar stroke (AIVBS) is usually associated with poor outcome and prognosis and in case of basilar artery occlusion (BAO) with high mortality. Intravenous thrombolysis (IVT), as a standard recanalization therapy of acute ischemic stroke (IS) within first 4.5 h, can be administrated beyond this therapeutic time window in case of symptomatic BAO. Repeated IVT is generally contraindicated in case of early recurrent IS, despite a risk of poor outcome or death after recurrent IS. The aim was to present 2 cases of repeated IVT for recurrent AIVBS and discuss specific situations where repeated IVT may be considered. Up to now, repeated IVT has been reported only in recurrent stroke in anterior circulation.

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

2019 ◽  
Vol 12 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Eike I Piechowiak ◽  
Johannes Kaesmacher ◽  
Felix Zibold ◽  
Tomas Dobrocky ◽  
Pascal J Mosimann ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Good Prognosis ◽  
Artery Occlusion ◽  
Favourable Outcome ◽  
High Rate ◽  
Basilar Artery Occlusion ◽  
Mortality And Morbidity ◽  
Tandem Occlusion ◽  
Vertebrobasilar Stroke

Background and purposeAcute basilar artery occlusion (BAO) is a devastating disease with a high rate of mortality and morbidity, and early recanalization is crucial to achieve a good prognosis. The best treatment strategy for BAO combined with a proximal stenosis (tandem occlusion) is not yet clear. Our study aimed to evaluate whether and how vertebrobasilar tandem occlusions can be treated effectively and safely compared with isolated BAO.Materials and methodsFifty-two patients with acute vertebrobasilar occlusive stroke treated with mechanical thrombectomy were identified in a prospective database from March 2010 to September 2016. We retrospectively analysed the clinical, technical, and functional outcomes of the patients.ResultsOf the 52 patients, 15 presented with a tandem occlusion, 14 with a single intracranial occlusion due to an underlying stenosis, and 23 with a single embolic BAO. Successful recanalization was achieved in all of the patients with tandem occlusions (modified Thrombolysis in Cranial Infarction 2b/3) and in 35 of 37 patients with a single BAO (with and without stenosis). A favourable outcome was achieved (modified Rankin Scale ≤2) in 8 of the 15 patients with a tandem occlusion compared with 4 of the 14 patients with a single BAO with underlying stenosis and 5 of the 23 patients with isolated embolic BAO (p=0.18).ConclusionsWe suggest that endovascular treatment of vertebrobasilar tandem occlusions is safe and feasible, with a high rate of good outcome.

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