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.

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).

scholarly journals Hybrid Retrograde-Antegrade Recanalization of Acute Basilar Artery Occlusion

2017 ◽  
Vol 6 (3-4) ◽  
pp. 263-267 ◽  
Author(s):  
James D. Rossen ◽  
Edgar A. Samaniego ◽  
Mishelle Paullus ◽  
Santiago Ortega-Gutierrez
Keyword(s):  
Basilar Artery ◽  
Poor Prognosis ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Technical Note ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
New Approach ◽  
Antegrade Approach ◽  
Buddy Wire

Acute basilar artery (BA) occlusion has a very poor prognosis. Recanalization can be challenged by bilateral vertebral artery (VA) occlusions, arterial dissection, or advanced atherosclerotic disease. We describe a case in whom the BA was accessed and recanalized through a retrograde-antegrade approach from the anterior circulation using a large posterior communicating artery (PCOM). Once the BA had been crossed retrogradely through the PCOM, another microcatheter was advanced antegradely through the VA into the BA and right posterior cerebral artery using the “buddy-wire” technique. In this way the BA was recanalized and reconstructed with stents. This technical note demonstrates a new approach to BA treatment when the antegrade access is hampered by advanced VA/BA disease or dissection.

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.

Republished: Where did the clot go? An unusual complication of mechanical thrombectomy caused by malignancy related subclavian steal phenomenon in a patient with acute basilar artery occlusion

2016 ◽  
Vol 9 (6) ◽  
pp. e22-e22
Author(s):  
Nikkie Randhawa ◽  
Jonathan P Squires ◽  
Manraj Kanwal Singh Heran ◽  
Sharanpal K Mann
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Unusual Complication ◽  
Vertebrobasilar Insufficiency ◽  
Basilar Artery Thrombosis ◽  
Steal Phenomenon ◽  
Subclavian Steal ◽  
Artery Embolism

Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.

Flow Diversion Radial Artery Bypass Graft Coupled With Terminal Basilar Artery Occlusion for the Treatment of Complex Basilar Apex Aneurysms: Operative Nuances

2013 ◽  
Vol 72 (2) ◽  
pp. ons116-ons126 ◽  
Author(s):  
Jeffrey C. Mai ◽  
Farzana Tariq ◽  
Louis J. Kim ◽  
Laligam N. Sekhar
Keyword(s):  
Scale Score ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Collateral Circulation ◽  
Posterior Cerebral Artery ◽  
Artery Bypass ◽  
Artery Occlusion ◽  
High Flow ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale

Abstract BACKGROUND: A subset of basilar apex aneurysms are unsuitable for either primary microsurgical clipping or endovascular coiling. These complex aneurysms can be treated by terminal basilar artery occlusion, but only if collateral circulation is adequate. To circumvent these complications, a high-flow vertebral artery-posterior cerebral artery or middle cerebral artery-posterior cerebral artery bypass may be performed to create an adequate collateral circulation to allow treatment of the aneurysm by basilar artery occlusion and/or clipping. OBJECTIVE: To discuss the operative nuances of this approach in the case of a 47-year-old man with progressive hemiparesis resulting from brainstem compression from a giant, unruptured basilar apex aneurysm with absent posterior communicating artery collaterals and incorporation of bilateral superior cerebellar arteries and posterior cerebral arteries within the aneurysm neck. METHODS: The patient underwent a staged bypass from V3 to P2 coupled with terminal basilar artery occlusion. RESULTS: The patient initially presented as modified Rankin Scale score 2 with right hemiparesis. The aneurysm ruptured after the first stage of the operation, and the patient underwent a V3 to P2 bypass the next day. His postprocedural neurologic decline improved at the 14-month follow-up to modified Rankin Scale score 2, with substantial reduction in aneurysm size observed at 9 months. The outcomes for 3 other bypass cases for basilar apex aneurysms are also summarized. CONCLUSION: We discuss the indications, preoperative diagnostic workup, operative management, and postoperative outcomes in managing challenging basilar apex aneurysms. In our experience, high-flow bypass procedures with or without hunterian ligation in the treatment of these aneurysms are well tolerated with good long-term results.

scholarly journals Isolated Basilar Artery Occlusion Associated with a Clivus Fracture

1989 ◽  
Vol 16 (1) ◽  
pp. 81-83 ◽  
Author(s):  
Abhijit Guha ◽  
Mahmood Fazl ◽  
Perry W. Cooper
Keyword(s):  
Basilar Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Vascular Injuries ◽  
Blunt Head Trauma ◽  
Basilar Occlusion ◽  
Clivus Fracture ◽  
Carotid Circulation ◽  
The Brain

ABSTRACT:Most vascular injuries to the brain secondary to blunt head trauma involve the internal carotid circulation. A case of isolated basilar occlusion secondary to a clival fracture is described and compared to three other cases in the literature.

Abstract WP84: MRI Based Scores Outperform CTA Based Scores in Predicting Outcome After Basilar Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Katarina Dakay ◽  
Amanda Ng ◽  
Justin F Fraser ◽  
Ali Mahta ◽  
Michael Reznik ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Prognostic Scores ◽  
Basilar Artery Occlusion ◽  
Roc Curve Analysis ◽  
Ct Angiogram ◽  
Magnetic Resonance Imaging Mri ◽  
Basilar Occlusion ◽  
Noninvasive Neuroimaging

Introduction: Clinical outcomes in patients with acute basilar occlusion (BAO) vary widely; several prognostic scores based on noninvasive imaging have been proposed. We aimed to compare the predictive value of several noninvasive neuroimaging scores in patients with BAO. Methods: We performed a single-center retrospective cohort study including all patients with acute BAO from 2015-2019. Using available clinical radiographic data, we calculated the following scores based on computed tomography (CT) and CT angiogram: Goyal posterior communicating artery score, posterior circulation collateral score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, pc-ASPECTS score, and pons-midbrain index. We also calculated the following scores based on diffusion-weighted (DWI) magnetic resonance imaging (MRI): Bern DWI score, MRI pc-ASPECTS, and pons-midbrain index on DWI. We then used logistic regression with area under the ROC curve analysis to determine the accuracy of each score in predicting favorable 3-month outcome (modified Rankin Scale 0-2). Results: Of 39 patients in our cohort, 92.3% underwent endovascular treatment (n=36) and 35.8% (n=14) had a favorable 3-month outcome. The Bern DWI score (AUC 0.790, 95% CI 0.619-0.960), pc-ASPECTS on MRI (AUC 0.880, 95% CI 0.601-0.958), and pons-midbrain index on MRI (AUC 0.764, 95% CI 0.594-0.934) accurately predicted 3-month outcome when analyzed as raw scores (Figure 1).: Conclusion: MRI scores more strongly predict outcome in BAO as compared to CTA collateral scores. Larger prospective studies are needed to confirm our findings.

scholarly journals Endovascular Therapy for Stroke due to Basilar Artery Occlusion: A BASIC Challenge at BEST

Stroke ◽  
2021 ◽  
Author(s):  
Thanh N. Nguyen ◽  
Daniel Strbian
Keyword(s):  
Basilar Artery ◽  
Endovascular Therapy ◽  
Large Scale ◽  
Randomized Trials ◽  
Artery Occlusion ◽  
High Rate ◽  
Basilar Artery Occlusion ◽  
Basilar Occlusion ◽  
Best Medical Therapy ◽  
Standard Medical Treatment

Basilar artery occlusion stroke is known to have poor outcome with a high rate of morbidity and mortality despite best medical therapy. Since the original report of intra-arterial therapy for basilar artery occlusion in 1983, two recent randomized trials comparing endovascular therapy versus best medical management were completed on a large scale, BASICS (Basilar Artery International Cooperation Study) and the BEST trial (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment), both of which demonstrated equivocal benefit of the two modalities. In this commentary, we comment and highlight important lessons related to basilar occlusion stroke as learned from the BASICS and BEST randomized trials.

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