scholarly journals Management challenge of basilar artery occlusion in SUS: Case report

2021 ◽  
Author(s):  
Isadora Santos Ferreira ◽  
Mauricio Elias Nunes da Silva ◽  
Liz Barros Rebouças ◽  
Rafael Bernhart Carra ◽  
Rene de Araújo Gleizer ◽  
...  
Keyword(s):  
Case Report ◽  
Basilar Artery ◽  
Intravenous Thrombolysis ◽  
Tertiary Hospital ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Basilar Artery Occlusion ◽  
High Morbidity ◽  
Basilar Artery Thrombosis ◽  
The Right

Context: Stroke caused by basilar artery occlusion is rare, corresponding to 1% of strokes. There is no consensus in the literature on the ideal management of this disease at acute phase. However, mechanical thrombectomy may be a viable treatment option. Case report: 68-year-old female, with no comorbidities, admitted to a secondary hospital 14h after headache, dizziness, vomiting and difficulty walking. She was disoriented, with severe dysarthria and dysphonia, horizontal and vertical ophthalmoparesis and pronation of the right upper limb (NIHSS: 4). Cranial tomography was normal and cranial angiotomography showed a basilar artery thrombosis. Patient was out of the window for intravenous thrombolysis and our hospital did not have another possibility of treatment. Due to high morbidity and mortality, also the possibility of neurological deterioration, medical contact was made with a tertiary hospital with hemodynamic service. During patient transference, she evolved with decreased level of consciousness, aphasia and tetraparesis (NIHSS: 18). Upon arrival at the hospital, a thrombectomy was performed due to an important clinical-radiological mismatch, 19 hours within symptoms onset and 3 hours after neurological worsening. After discharge, patient walked with assistance and physical examination showed a significant improvement in neurological deficits (NIHSS: 6). Conclusions: This case demonstrates the importance of engaging Brazil’s public health system in the management of acute ischemic stroke, especially in challenging cases such as basilar artery occlusion. This patient was the first admitted to our hospital to perform a thrombectomy after effective transference for a tertiary hospital and staff engagement of both hospitals.

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.

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.

Abstract TMP13: Tenecteplase versus Alteplase Before Endovascular Therapy in Basilar Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fana Alemseged ◽  
Volker Puetz ◽  
Gregoire Boulouis ◽  
Alessandro Rocco ◽  
Timothy Kleinig ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Endovascular Therapy ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Randomized Controlled ◽  
Repeat Imaging

Background: Tenecteplase (TNK) is a genetically modified variant of alteplase with greater fibrin specificity and longer half-life than alteplase. The recent Tenecteplase versus Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK) trial demonstrated that increased reperfusion with TNK compared to alteplase prior to endovascular thrombectomy (EVT) in large vessel occlusion ischaemic strokes. However, only 6 patients with basilar artery occlusion (BAO) were included. We aimed to investigate the efficacy of TNK versus alteplase before EVT in patients with basilar artery occlusion (BAO). Methods: Clinical and procedural data of consecutive BAO diagnosed on CT Angiography or MR Angiography from the multisite international Basilar Artery Treatment and MANagement (BATMAN) collaboration were retrospectively analysed. The primary outcome was reperfusion of greater than 50% of the involved ischemic territory or absence of retrievable thrombus at the time of the initial angiographic assessment. Results: We included 119 BAO patients treated with intravenous thrombolysis prior to EVT; mean age 68 (SD 14), median NIHSS 16 (IQR 7-32). Eleven patients were treated with TNK (0.25mg/kg or 0.4mg/kg) and 108 with alteplase (0.9mg/kg). Overall, 113 patients had catheter angiography or early repeat imaging after thrombolysis. Reperfusion of greater than 50% of the ischemic territory or absence of retrievable thrombus occurred in 4/11 (36%) of patients treated with TNK vs 8/102 (8%) treated with alteplase (p=0.02). Onset-to-needle time did not differ between the two groups (p=0.4). Needle-to-groin-puncture time was 61 (IQR 33-100) mins in patients reperfused with TNK vs 111 (IQR 86-198) mins in patients reperfused with alteplase (p=0.048). Overall, the rate of symptomatic haemorrhage was 3/119 (2.5%). No differences were found in the rate of symptomatic intracranial haemorrhage (p=0.3) between the two thrombolytic agents. Conclusions: Despite shorter needle-to-groin-puncture times, tenecteplase was associated with an increased rate of reperfusion in comparison with alteplase before EVT in BAO. Randomized controlled trials to compare tenecteplase with alteplase in BAO patients before endovascular thrombectomy are warranted.

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 Timing of Recanalization After Microbubble-Enhanced Intravenous Thrombolysis in Basilar Artery Occlusion

Stroke ◽  
2007 ◽  
Vol 38 (11) ◽  
pp. 2931-2934 ◽  
Author(s):  
Jorge Pagola ◽  
Marc Ribo ◽  
José Alvarez-Sabín ◽  
Marcos Lange ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

scholarly journals A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Katleen Devue ◽  
Annemie Van Ingelgem ◽  
Katrien De Keukeleire ◽  
Marc De Leeuw
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Minor Trauma ◽  
Systemic Thrombolysis ◽  
The Right

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

scholarly journals Intravenous Thrombolysis of Basilar Artery Occlusion

Stroke ◽  
2014 ◽  
Vol 45 (6) ◽  
pp. 1733-1738 ◽  
Author(s):  
Daniel Strbian ◽  
Tiina Sairanen ◽  
Heli Silvennoinen ◽  
Oili Salonen ◽  
Perttu J. Lindsberg
Keyword(s):  
Basilar Artery ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?

2016 ◽  
Vol 37 (7) ◽  
pp. 1137-1140 ◽  
Author(s):  
Pietro Caliandro ◽  
Giuseppe Reale ◽  
Tommaso Tartaglione ◽  
Paolo Maria Rossini
Keyword(s):  
Basilar Artery ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

scholarly journals Basilar Artery Occlusion. Clinical Evaluation and Contemporary Methods of Treatment

2021 ◽  
Vol 4 (01) ◽  
pp. 01-08
Author(s):  
Damyan Boychev
Keyword(s):  
Basilar Artery ◽  
Neurological Diseases ◽  
Intravenous Thrombolysis ◽  
Mortality Rates ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Threatening Condition ◽  
Life Threatening ◽  
Methods Of Treatment ◽  
Headache And Neck Pain

Acute occlusion of the basilar artery and its branches is a frequent cause of posterior circulation strokes. Although it accounts for only 1 to 3 % of ischemic strokes, it is a potentially life-threatening condition associated with high mortality rates. Exact clinical diagnosis is still challenging because symptoms such as vertigo, dizziness followed by headache, and neck pain are nonspecific and usually attributed to many other neurological diseases. The onset of symptoms can be abrupt or gradual and progressive. Establishing the time of symptoms onset and making a timely diagnosis is highly important. In case the diagnosis is made promptly, ideally with the help of an advanced neuroimaging, intravenous thrombolysis, or catheter-based endovascular treatment can be performed immediately to improve prognosis and reduce mortality.

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