Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature

Nicosia, Giancarlo; Cicala, Domenico; Mirone, Giuseppe; Spennato, Pietro; Trischitta, Vincenzo; Ruggiero, Claudio; Guarneri, Gianluigi; Muto, Mario; Cinalli, Giuseppe

doi:10.1007/s00381-016-3259-z

Cited by 15 publications

(14 citation statements)

References 27 publications

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“…9 This was in line with our results. In most studies, stent retrievers are used in up to 82% of patients as a first option, 9 , 25 , 28–35 reflecting the guidelines for stroke treatment in adults. In our center, aspiration as first intention has now replaced stentrievers, and was used in 4 (57%) of our patients.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of pediatric ischemic stroke: A single center experience and review of the literature

et al. 2020

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Introduction Mechanical thrombectomy is standard treatment for large vessel occlusion (LVO) in adults. There are no randomized controlled trials for the pediatric population. We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. Methods Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. Results In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2–17), and median Ped-NIHSS was 15 (3–24), and the median ASPECTS was 8 (2–10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from onset of symptoms to beginning of treatment was 7h06m (2h58m–21h38m). Five patients had middle cerebral artery occlusions. Thrombectomy was performed using a stentriever in 3 patients, aspiration in 3 patients, and combined technique in 1 patient. Six patients had good recanalization (TICI 2 b/3). There were no immediate periprocedural complications. At 3 months, 4 patients (57%) were independent (mRS score <3). Two patients died, one after haemorrhagic transformation of an extensive MCA infarct, and one due to extensive brainstem ischemia in the setting of varicella vasculitis. Discussion Selected pediatric patients with LVO may be treated with mechanical thrombectomy safely. In patients under external cardiac assistance and under anticoagulation, thrombectomy is the only alternative for treatment of LVO. A multidisciplinary approach in specialized pediatric stroke centers with trained neurointerventionalists are essential for good results.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of pediatric ischemic stroke: A single center experience and review of the literature

et al. 2020

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“…Since that study, there have been other reports on successful reopening of the basilar artery or posterior cerebral arteries by endovascular thrombectomy and other treatments. [ 45 53 60 67 83 91 96 116 118 122 ] Gory et al . [ 67 ] reviewed the literature on all previous studies of stent retriever thrombectomy in BAO patients with stroke between November 2010 and April 2014.…”

Section: Chronological Review Of Pcd Literaturementioning

confidence: 99%

“…(1) There were reports of the successful use of stent retrieval systems to remove a basilar artery thrombosis, a subset of the universe of PCD. [ 21 45 53 60 67 83 91 96 110 116 118 122 ]…”

Section: Introduction - Short Summary Of This Paper For the Reader Wmentioning

confidence: 99%

A review of the diagnosis and management of vertebral basilar (posterior) circulation disease

Ausman¹,

Liebeskind²,

Gonzalez³

et al. 2018

Surg Neurol Int

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We have reviewed the English literature published in the last 70 years on Diseases of the Vertebral Basilar Circulation, or Posterior Circulation Disease (PCD). We have found that errors have been made in the conduct and interpretation of these studies that have led to incorrect approaches to the management of PCD. Because of the difficulty in evaluating the PC, the management of PCD has been incorrectly applied from anterior circulation disease (ACD) experience to PCD. PCD is a common form of stroke affecting 20-40% patients with stroke. Yet, the evidence is strong that the Anterior Circulation (AC) and Posterior Circulations (PC) differ in their pathology, in their clinical presentations, in the rapidity of development of symptoms, in optimal imaging methods, and in available treatments.There appears to be two categories of patients who present with PCD. The first, acute basilar artery occlusion has a more rapid onset. The diagnosis must be made quickly and if imaging proves a diagnosis of Basilar Artery Occlusion (BAO), the treatment of choice is Interventional removal of the basilar artery thrombosis or embolus. The second category of PCD and the most commonly seen PCD disease process presents with non-specific symptoms and early warnings of PCD that now can be related to ischemic events in the entire PC vessels. These warning symptoms and signs occur much earlier than those in the AC.IA angiography is still the gold standard of diagnosis and is superior in definition to MR and CT angiography which are commonly used as a convenient screening imaging tool to evaluate PCD but are both inferior to IA angiography in definition for lesions below 3-4 mm. In at least two reported studies 7T MR angiography appears superior to other imaging modalities and will become the gold standard of imaging of PCD in the future. Medical treatments applied to the ACD have not been proven of value in specific forms of PCD. Interventional therapy was promising but of unproven value in Randomized Controlled Trials (RCT) except for the treatment of Basilar Artery Occlusion (BAO).Surgical revascularization has been proved to be highly successful in patients, who are refractory to medical therapy. These studies have been ignored by the scientific community basically because of an incorrect interpretation of the flawed EC-IC Bypass Trial in 1985 as applying to all stroke patients. Moreover, the EC-IC Bypass Study did not include PCD patients in their study population, but the study results were extrapolated to patients with PCD without any scientific basis. This experience led clinicians to an incorrect bias that surgical treatments are of no value in PCD. Thus, incorrectly, surgical treatments of PCD have not been considered among the therapeutic possibilities for PCD.QMRA is a new quantitative MR technique that measures specific blood flow in extra and intracranial vessels. QMRA has been used to select those patients who may benefit from medical, or interventional, or surgical treatment for PCD based on flow determinations with a high ...

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“…As far as we have identified, 10 reports have described 15 patients with VBAD that resulted in AIS treated by urgent endovascular reperfusion therapy since 2010. 1,3,[16][17][18][19][20][21][22][23] The information regarding the reported 15 patients and the three cases from this report is summarized in Table 1.…”

Section: Incidence Of Vbad In Acute Large Vessel Occlusionsmentioning

confidence: 99%

Endovascular Treatment for Acute Ischaemic Stroke Caused by Vertebral Artery Dissection: A Report of Three Cases and Literature Review

Kondo

Ishihara

Uemiya

et al. 2021

NMC Case Report Journal

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Vertebrobasilar artery dissection is an uncommon cause of acute ischaemic stroke (AIS). Optimal endovascular management has not been established. This study aimed to share our experience with endovascular reperfusion therapy for vertebrobasilar artery occlusion due to vertebral artery dissection (VAD). We retrospectively reviewed 134 consecutive patients with AIS who received urgent endovascular reperfusion therapy between November 2017 and November 2019. Three patients diagnosed with VAD were investigated. The evaluation included mechanisms of vertebrobasilar artery occlusion due to VAD, variations in endovascular procedures, and functional outcomes. Dissections at the V3, V4 and extension of V3 to V4 segments were seen in one patient each. The mechanism of AIS was different in each patient: occlusion of the distal non-dissected artery due to an embolus from the dissection site ( distal occlusion ), haemodynamic collapse of the entire vertebrobasilar artery system due to the arterial dissection itself ( local occlusion ), or coexistence of distal occlusion and local occlusion ( tandem occlusion ). The endovascular reperfusion therapy was performed corresponding to the abovementioned mechanisms: mechanical thrombectomy for distal occlusion , stenting for local occlusion , and a combination of thrombectomy and stenting for tandem occlusion . In all three patients, effective recanalization and functional independence (modified Rankin Scale scores of 0–2 at 90 days after the onset) were achieved. Endovascular treatment corresponding to the individual mechanism of AIS may improve patient outcomes.

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Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature

Cited by 15 publications

References 27 publications

Endovascular treatment of pediatric ischemic stroke: A single center experience and review of the literature

Endovascular treatment of pediatric ischemic stroke: A single center experience and review of the literature

A review of the diagnosis and management of vertebral basilar (posterior) circulation disease

Endovascular Treatment for Acute Ischaemic Stroke Caused by Vertebral Artery Dissection: A Report of Three Cases and Literature Review

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