Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke

Cohen, José E.; Leker, Ronen R.; Gomori, John M.; Eichel, Roni; Rajz, Gustavo; Moscovici, Samuel; Itshayek, Eyal

doi:10.1016/j.jocn.2016.05.005

“…However, a previous study showed that patients with tandem lesions who were comparable with those without tandem vertebrobasilar occlusions presented similar clinical outcomes. 26 Only in recent years has vertebral artery origin occlusion been more fully characterized and defined as a potential source of embolic stroke and as a potential predictor of mortality in acute BAO. 27 Thirdly, underlying ICAS in the target artery can make the thrombectomy procedure more complicated and require additional rescue treatments such as angioplasty with or without stenting and intra-arterial infusion of antiplatelet drugs.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

¹

,

Tong

²

,

Gao

³

et al. 2019

Preprint

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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.

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“…Therefore, emergency revascularization of acute tandem vertebrobasilar occlusion with stent retrievers with or without concomitant stenting of the underlying stenotic or occlusive lesion is an emerging treatment option for this complex form of stroke. Only a few published studies have addressed technical aspects and outcome in this subpopulation of patients with acute vertebrobasilar occlusion stroke 15–19. In these cases, endovascular treatment is more challenging and the best approaches for access, the use of extracranial and intracranial permanent stenting, and optimal treatment strategies to enhance recanalization rates, avoid peri-procedural complications, and improve clinical outcome have yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

Piechowiak

¹

,

Kaesmacher

²

,

Zibold

³

et al. 2019

J NeuroIntervent Surg

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Background and purposeAcute basilar artery occlusion (BAO) is a devastating disease with a high rate of mortality and morbidity, and early recanalization is crucial to achieve a good prognosis. The best treatment strategy for BAO combined with a proximal stenosis (tandem occlusion) is not yet clear. Our study aimed to evaluate whether and how vertebrobasilar tandem occlusions can be treated effectively and safely compared with isolated BAO.Materials and methodsFifty-two patients with acute vertebrobasilar occlusive stroke treated with mechanical thrombectomy were identified in a prospective database from March 2010 to September 2016. We retrospectively analysed the clinical, technical, and functional outcomes of the patients.ResultsOf the 52 patients, 15 presented with a tandem occlusion, 14 with a single intracranial occlusion due to an underlying stenosis, and 23 with a single embolic BAO. Successful recanalization was achieved in all of the patients with tandem occlusions (modified Thrombolysis in Cranial Infarction 2b/3) and in 35 of 37 patients with a single BAO (with and without stenosis). A favourable outcome was achieved (modified Rankin Scale ≤2) in 8 of the 15 patients with a tandem occlusion compared with 4 of the 14 patients with a single BAO with underlying stenosis and 5 of the 23 patients with isolated embolic BAO (p=0.18).ConclusionsWe suggest that endovascular treatment of vertebrobasilar tandem occlusions is safe and feasible, with a high rate of good outcome.

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“…However, a previous study showed that patients with tandem lesions who were comparable with those without tandem vertebrobasilar occlusions presented similar clinical outcomes. 26 Only in recent years has occlusion of the vertebral artery origin been more fully characterized and defined as a potential source of embolic stroke and as a potential predictor of mortality in acute BAO. 27 Third, underlying ICAS in the target artery can make the thrombectomy procedure more complicated and require additional rescue treatments such as angioplasty with or without stenting and intra-arterial infusion of antiplatelet drugs.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

¹

,

Tong

²

,

Gao

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

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.

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Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke

Cited by 44 publications

References 16 publications

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

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

Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

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

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