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

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.

Quality of life in stroke patients in residual stroke period and its determinants

Stroke remains one of the leading causes of disability; therefore, it is important to investigate factors that might affect the quality of life of stroke patients and refine rehabilitation technologies for better functional gains. The aim of this paper was to study possible factors that determine the quality of life in the residual ischemic stroke period. The MOS SF-36 health survey was completed by 210 patients undergoing early rehabilitation at a stroke care unit. The study revealed a significant decline in some quality of life indicators correlated with advancing age and severity of the condition (correlation coefficient –0.5; p < 0.01). Both physical and mental component summary scores were lower in women than in men (p < 0.01 and p < 0.001, respectively). High scores on the majority of the applied subscales were observed in the patients with a vertebrobasilar stroke, as compared with those who had suffered a carotid stroke (p < 0.05). The early rehabilitation regimen complemented with acupuncture in the acute stroke period and the subsequent rehabilitation program at the Rehabilitation Hospital significantly contributed (р < 0.05) to improving the quality of life of stroke patients in the residual stroke period.

Non-thrombotic vertebrobasilar stroke in Crohn’s disease patient

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that could affect any part of the gastrointestinal tract. The association between posterior circulation stroke and Crohn’s disease is rarely reported and was controversial for long time. We report herein a case of a stroke in the right posterior inferior cerebellar artery (PICA) territory in a male patient with no cardiovascular risk factors who was monitored for ileocolic active Crohn’s Disease. The aim is to assess the pathophysiological correlation between this inflammatory condition and the predominance of vertebrobasilar strokes and to highlight appropriate management characteristics.

Mechanical Thrombectomy for Tandem 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.