Posterior circulation tandem occlusions: Classification and techniques

Weinberg, Joshua; Sweid, Ahmad; Sajja, Kalyan; Abbas, Rawad; Asada, Ashlee; Kozak, Osman; MacKenzie, Larami; Choe, Hana; Gooch, M. Reid; Herial, Nabeel; Tjoumakaris, Stavropoula; Zarzour, Hekmat; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1016/j.clineuro.2020.106154

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…In previous studies, posterior circulation tandem occlusions were associated with mortality rates of 20-42.9% and good outcomes (mRS 0-2) in only 28.6-53.3%. [3][4][5]12,16,17 In our study, five patients (55.5%) had good outcomes with a mRS score of 0-2 at 90 days and the mortality rate was 11.1%, which are similar to previously literature. [3][4][5]12,16,17 This study has several limitations.…”

Section: Discussionsupporting

confidence: 90%

“…[3][4][5]12,16,17 In our study, five patients (55.5%) had good outcomes with a mRS score of 0-2 at 90 days and the mortality rate was 11.1%, which are similar to previously literature. [3][4][5]12,16,17 This study has several limitations. First, this was a single-center empirical retrospective analysis, the sample size was relatively small.…”

Section: Discussionsupporting

confidence: 90%

“…In previous studies, posterior circulation tandem occlusions were associated with mortality rates of 20–42.9% and good outcomes (mRS 0-2) in only 28.6–53.3%. 3–5,12,16,17…”

Section: Discussionmentioning

confidence: 99%

“…In our study, five patients (55.5%) had good outcomes with a mRS score of 0–2 at 90 days and the mortality rate was 11.1%, which are similar to previously literature. 3–5,12,16,17…”

Section: Discussionmentioning

confidence: 99%

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Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority

et al. 2022

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Purpose To illustrate the characteristics of acute ostial vertebral artery (VA) and basilar artery (BA) tandem occlusions. The endovascular treatment strategy for ostial VA-BA tandem occlusion was reported. Materials and Methods We conducted a retrospective analysis of patients with ostial VA-BA tandem occlusion who underwent endovascular treatment in our center between November 2018 and February 2022. We preferred to recanalize the dominant vertebral artery with priority. The imaging characteristics, treatment strategy, clinical outcomes, and complications were analyzed. Results In total, 9 patients with ostial VA-BA tandem occlusion were enrolled in this study. All the VA-BA tandem occlusion was caused by acute occlusion of the dominant VA. Endovascular revascularization was performed through the occluded dominant VA in 8 patients and was performed through contralateral non-dominant VA in 1 patient. Successful recanalization (mTICI 2b/3 grade) was achieved in all 9 patients, and 5 patients (55.5%) achieved functional independence with a mRS score of 0–2 at 90 days. Conclusions In this case series, the occurrence of ostial VA-BA tandem occlusions was mainly caused by acute occlusion of the dominant VA. Endovascular revascularization of ostial VA-BA tandem occlusions through occluded dominant VA was feasible and recommended.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

“…In previous studies, posterior circulation tandem occlusions were associated with mortality rates of 20–42.9% and good outcomes (mRS 0-2) in only 28.6–53.3%. 3–5,12,16,17…”

Section: Discussionmentioning

confidence: 99%

“…In our study, five patients (55.5%) had good outcomes with a mRS score of 0–2 at 90 days and the mortality rate was 11.1%, which are similar to previously literature. 3–5,12,16,17…”

Section: Discussionmentioning

confidence: 99%

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Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority

et al. 2022

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“…The basilar artery can be accessed via the patent or the occluded VA, and each route has advantages and disadvantages. 4 , 6 , 7 The patent VA approach is safe and can be performed rapidly. However, it does not address the contralateral VA occlusion.…”

Section: Discussionmentioning

confidence: 99%

Acute reperfusion therapy via occluded vertebral artery using a guiding sheath for posterior circulation tandem occlusion: illustrative case

Ishikawa

Endo

Nomura

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Vertebral artery (VA) size, anatomy, and occlusion status should be considered when selecting endovascular access for basilar artery mechanical thrombectomy. In a patient with concomitant basilar artery and VA occlusion and a patent but hypoplastic contralateral VA, the occluded VA should be selected. The authors report a technique that utilizes advancing a guiding sheath with attached dilator via an occluded VA. OBSERVATIONS A 65-year-old male presented with disturbed consciousness because of an acute infarction of the brainstem and cerebellum caused by a basilar artery occlusion. Cerebral angiography showed a hypoplastic right VA and occlusion of the left VA at the origin. A regular wire was easily advanced through the occlusion and a 4-Fr diagnostic catheter was advanced into the distal left VA. A 6-Fr guiding sheath with attached dilator was placed in the left VA beyond the occlusion by exchanging it over a long wire. After removing the basilar artery thrombus, balloon angioplasty was performed at the left VA origin. Complete revascularization of the posterior circulation was achieved. LESSONS A guiding sheath with dilator can advance across and dilate a VA occlusion at the origin to provide rapid access to the basilar artery.

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Outcomes Following Mechanical Thrombectomy in Different Etiological Subtypes of Acute Basilar Artery Occlusion

et al. 2022

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Posterior circulation tandem occlusions: Classification and techniques

Cited by 7 publications

References 15 publications

Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority

Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority

Acute reperfusion therapy via occluded vertebral artery using a guiding sheath for posterior circulation tandem occlusion: illustrative case

Outcomes Following Mechanical Thrombectomy in Different Etiological Subtypes of Acute Basilar Artery Occlusion

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