scholarly journals Roadmap Guided Direct Percutaneous Vertebral Artery Puncture for Mechanical Thrombectomy of Acute Basilar Artery Occlusion: A Technical Case Report and Review of the Literature

2022 ◽  
Vol 12 ◽  
Author(s):  
Jawed Nawabi ◽  
Georg Bohner ◽  
Eberhard Siebert
Keyword(s):  
Vertebral Artery ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Target Vessel ◽  
Anterior Circulation ◽  
Direct Puncture ◽  
Safety Issues

Access techniques for mechanical thrombectomy normally include percutaneous puncture of the common femoral or, more recently, the radial artery. Although target vessel catheterization may frequently not be devoid of difficulties via both routes, the vast majority of mechanical thrombectomy (MT) cases can be successfully managed. However, in a significant minority of cases, a stable target vessel access cannot be reached resulting in futile recanalization procedures and detrimental outcomes for the patients. As such, in analogy to direct carotid puncture for anterior circulation MT, direct vertebral artery (VA) puncture (DVP) is a direct cervical approach, which can constitute the only feasible access to the posterior circulation in highly selected cases. So far, due to the rarity of DVP, only anecdotal evidence from isolated case reports is available and this approach raises concerns with regard to safety issues, feasibility, and technical realization. We present a case in which bail-out access to the posterior circulation was successfully obtained through a roadmap-guided lateral direct puncture of the V2 segment of the cervical VA and give an overview of technical nuances of published DVP approaches for posterior circulation MT.

Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

2021 ◽  
Keyword(s):  
General Anaesthesia ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

scholarly journals Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

2019 ◽  
Vol 11 (12) ◽  
pp. 1174-1180 ◽  
Author(s):  
Thomas Raphael Meinel ◽  
Johannes Kaesmacher ◽  
Panagiotis Chaloulos-Iakovidis ◽  
Leonidas Panos ◽  
Pasquale Mordasini ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Secondary Outcome ◽  
Stroke Severity ◽  
Anterior Circulation ◽  
Link Type ◽  
Significant Difference

BackgroundPerforming mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.ObjectiveTo compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.MethodsIn the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.ResultsMT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.ConclusionsIn selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.Trial registration numberNCT03496064

scholarly journals Successful mechanical thrombectomy of acute basilar artery occlusion caused by vertebral artery intimal dysplasia (web)

2020 ◽  
Vol 176 (3) ◽  
pp. 210-213
Author(s):  
C. Dargazanli ◽  
I. Arnaud ◽  
I. Seiller ◽  
A. Signaté ◽  
M. Mejdoubi
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

scholarly journals Endovascular Treatment for Acute Basilar Artery Occlusion: A Single Center Retrospective Observational Study

2019 ◽  
Author(s):  
xuan sun ◽  
xu tong ◽  
feng gao ◽  
huiting lao ◽  
zhongrong miao
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
High Volume ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Intracranial Atherosclerotic Disease

Abstract Background and purpose: Endovascular treatment (EVT) is now considered the gold standard for select patient populations with anterior circulation stroke; however, data on the treatment of posterior circulation stroke are less clear. This study aims to determine the characteristics and treatment outcomes of patients with acute basilar artery occlusion (BAO) and to evaluate the effectiveness and safety of EVT for patients with acute BAO in a high-volume stroke center. Methods: This study included 187 consecutive patients with acute BAO who underwent EVT from January 2012 to July 2018 in Beijing Tiantan Hospital. The baseline characteristics, procedure parameters, and functional outcome were assessed. Results: Among the 187 patients, 138 (73.8%) underwent mechanical thrombectomy with a stent retriever, 33 (17.6%) underwent direct intracranial angioplasty (balloon dilation and/or stent implantation) for underlying severe intracranial atherosclerotic disease, and 91 (48.7%) underwent combined mechanical thrombectomy and angioplasty. Successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3] was achieved in 158 patients (84.5%). Overall, the rates of functional independence [modified Rankin Scale (mRS) 0-2] and favorable outcome (mRS 0-3) at 90 days were 36.4% and 49.2%, respectively, and 90- day all-cause mortality was 20.3%. Conclusion􀀌􀀁EVT was effective and safe for treating patients with acute BAO.

Republished: Basilar artery occlusion in a child treated successfully with mechanical thrombectomy using ADAPT

2016 ◽  
Vol 9 (1) ◽  
pp. e2-e2 ◽  
Author(s):  
Jonathan Lena ◽  
Ramin Eskandari ◽  
Libby Infinger ◽  
Kyle M Fargen ◽  
Alejandro Spiotta ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Pediatric Population ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
First Case ◽  
Intravenous Tissue Plasminogen Activator ◽  
First Pass ◽  
Tissue Plasminogen ◽  
Arterial Thrombolysis

Acute ischemic stroke (AIS) in the pediatric population is rare. Furthermore, it is common for physicians to take significantly longer diagnosing a posterior circulation stroke in a child than in an adult. There are increasing case reports in the literature of treating AIS in children with intravenous tissue plasminogen activator, intra-arterial thrombolysis, and/or mechanical thrombectomy. We present the first case of pediatric AIS treated using a direct aspiration first pass technique (ADAPT) as a means of mechanical thrombectomy.

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 Case Report: Four Early Recurrent Basilar Artery Occlusions Successfully Treated With Mechanical Thrombectomy and Subsequent Vertebral Artery Coil Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Stefan L. Leber ◽  
Simon Fandler-Höfler ◽  
Markus Kneihsl ◽  
Michael Augustin ◽  
Hannes Deutschmann ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Basilar Artery Occlusion ◽  
Stroke Work ◽  
Cerebrovascular Events ◽  
Coil Occlusion ◽  
The Right

We present the case of a middle-aged patient who had four recurrent acute basilar artery occlusions over a period of 3 months, each time successfully treated with mechanical thrombectomy. Extensive stroke work-up showed no obvious stroke etiology aside from a dysplastic right vertebral artery with multifocal stenoses. Treatment with different antiplatelet and anticoagulant regimes did not prevent basilar artery occlusion recurrence. Therefore, transarterial coil occlusion of the V4-segment of the right vertebral artery was performed as ultima ratio without complications. At final discharge, the patient had no persistent neurological deficits. No further cerebrovascular events occurred over a 12-month follow-up period.

Sign in / Sign up

Export Citation Format

Share Document