scholarly journals A Narrative Review of Contemporary Global Perspectives into Epidemiology, Treatment, and Prognosis of Vertebrobasilar Strokes

2021 ◽  
Vol 4 (3) ◽  
pp. 418-429
Author(s):  
Samwel Msigwa
Keyword(s):  
Time Window ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Narrative Review ◽  
Basilar Artery Occlusion ◽  
Management Options ◽  
Significant Disabilities ◽  
Global Perspectives ◽  
Stent Restenosis ◽  
Standard Medical Therapy

Blood flow interruptions to the posterior cerebral circulation hallmark vertebrobasilar strokes (VBS), leading to mortality and significant disabilities, yet optimal therapy prevails unpublished. Recent epidemiological evidence indicates that VBS account for nearly 1/5 of all ischemic strokes globally, with acute basilar artery occlusion (BAO) contributing significant disabilities in nearly 1/3 of the victims. The prevalence of VBS in Africa is close to 5%, majorly in large intracranial vessels. Etiologically, Stenosis accounts for 20% of all VBS, while aneurysms face up to a 3% rupture rate. Furthermore, intravenous alteplase is the gold standard medical therapy for the cases presenting within 3 to 4.5 hours post-baseline regarding management options. Nevertheless, there is no consensus for BAO beyond 4.5 hours post-onset. Stent retrievers are the first-line endovascular reperfusion therapy device proposed. However, an 18% risk of in-stent restenosis is a significant drawback. Comprehensive prognostic factors are addressed in this review. However, prospective, multicenter, controlled studies are needed to clarify the time window dilemmas facing posterior circulation strokes. This narrative review explores recent VBS epidemiology, management advances, and prognosis.Rwanda J Med Health Sci 2021;4(3):418-429

scholarly journals Safety and Efficacy of Endovascular Treatment for Progressive Stroke in Patients With Acute Basilar Artery Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Yinxu Wang ◽  
Yingbing Ke ◽  
Lingling Wang ◽  
Qing Wu ◽  
Jing Zhou ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Basilar Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Treatment Time ◽  
Time Window ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Standard Medical Therapy ◽  
Desirable Outcome

Background and Purpose: It is unknown the benefit of endovascular therapy (EVT) for progressive stroke in patients with basilar artery occlusion (BAO). The aim of this study was to compare the efficacy and safety of EVT with standard medical therapy (SMT) in a population of BAO patients with progressive stroke.Methods: The EVT for Acute Basilar Artery Occlusion Study (BASILAR) is a national prospective registry of consecutive patients with acute BAO within 24 h of symptom onset. According to the applied therapy, all patients were divided into SMT and EVT groups. Subsequently, the EVT group was divided into early (≤6 h) and late groups (>6 h) according to the time window. The efficacy outcome was favorable functional outcomes (modified Rankin Scale score ≤ 3) at 90 days. The safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage (sICH) after EVT.Results: The EVT cohort presented more frequently with a favorable functional outcome (adjusted odds ratio, 5.49; 95% confidence interval, 2.06–14.61, p = 0.01) and with a decreased mortality (adjusted odds ratio, 0.3; 95% confidence interval, 0.17–0.54, p < 0.001). What's more, EVT still safe (P = 0.584, P = 0.492, respectively) and effective (P = 0.05) in patients with progressive stroke when the treatment time window exceeds 6 h.Conclusions: EVT was more effective and safer than SMT for progressive stroke in patients with BAO. Besides, EVT remains safe and effective in patients with progressive stroke when the treatment time window exceeds 6 h. Predictors of desirable outcome in progressive stroke patients undergoing EVT included lower baseline NIHSS score, higher baseline pc-ASPECTs, successful recanalization and shorter puncture to recanalization time.

scholarly journals The history of basilar artery occlusion: when art aids science

2018 ◽  
Vol 76 (5) ◽  
pp. 355-357
Author(s):  
Francisco Antunes Dias ◽  
Daniel Giansante Abud ◽  
Octavio Marques Pontes-Neto
Keyword(s):  
Basilar Artery ◽  
Rare Condition ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
High Morbidity ◽  
Medical Sciences ◽  
Randomized Controlled ◽  
History Of ◽  
The Impact

ABSTRACT Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.

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 Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 49-55
Author(s):  
Huong Bich Thi Nguyen ◽  
Thang Huy Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Large Artery ◽  
Limited Information ◽  
Anterior Circulation ◽  
Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

scholarly journals Aggressive Endovascular Reperfusion Therapy for Acute Basilar Artery Occlusion

2011 ◽  
Vol 20 (9) ◽  
pp. 678-685
Author(s):  
Yoshitaka Tanaka ◽  
Shinichi Yoshimura ◽  
Yusuke Egashira ◽  
Kiyofumi Yamada ◽  
Yukiko Enomoto ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

scholarly journals Predictors of Outcome After Endovascular Thrombectomy in Acute Basilar Artery Occlusion and the 6hr Time Window to Recanalization

2019 ◽  
Vol 10 ◽  
Author(s):  
Johannes Ravindren ◽  
Marta Aguilar Pérez ◽  
Victoria Hellstern ◽  
Pervinder Bhogal ◽  
Hansjörg Bäzner ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Time Window ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Predictors Of Outcome ◽  
Endovascular Thrombectomy

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.

scholarly journals Predicting outcomes after acute reperfusion therapy for basilar artery occlusion

2020 ◽  
Vol 27 (11) ◽  
pp. 2176-2184
Author(s):  
A. P. Jadhav ◽  
S. M. Desai ◽  
D. M. Panczykowski ◽  
S. Rangaraju ◽  
D. Campbell ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

Thrombectomy for acute basilar artery occlusion by using double Merci retriever devices and bilateral temporary vertebral artery flow reversal

2009 ◽  
Vol 111 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Frédéric Clarençon ◽  
Raphaël Blanc ◽  
Sophie Gallas ◽  
Hassan Hosseini ◽  
André Gaston
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Flow Reversal ◽  
Clinical Event ◽  
Basilar Artery Occlusion ◽  
Mechanical Removal ◽  
Standard Medical Therapy ◽  
Intravenous Tissue Plasminogen Activator ◽  
Anticoagulation Agents

Basilar artery occlusion is a dramatic clinical event with a high mortality rate if patients are treated by standard medical therapy, including anticoagulation agents. The use of intravenous tissue plasminogen activator or intraarterial thrombolysis recanalizes 30–53 and 64%, respectively, of patients with basilar stroke. Mechanical endovascular treatments allow tailored procedures with quicker results and higher recanalization rates. The authors describe a successful mechanical removal of an obstruction in an acute occlusion of the basilar artery tip involving both proximal segments of posterior cerebral arteries in a 20-year-old man. They used 2 Merci retriever devices at the same time, and performed bilateral proximal vertebral artery occlusion for temporary flow reversal and aspiration.

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.

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