Thrombectomy using Trevo ProVue Stent Retriever Devices after Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Basilar Artery Occlusion during Vertebral Artery Dissection

Abstract

A 41-year-old woman was admitted due to a sudden-onset severe headache, left hemiparesis and dysarthria. Diffusion-weighted magnetic resonance imaging showed an acute infarct in the bilateral pons, and magnetic resonance angiography revealed basilar artery (BA) occlusion resulting from dissection of the right vertebral artery (VA). She was treated with intravenous recombinant tissue plasminogen activator (rt-PA) 110 minutes after symptom onset. Subsequently, brain angiography was performed along with mechanical thrombolysis using Trevo ProVue retriever devices. The BA was successfully recanalized 240 minutes after the onset of symptoms. Thrombectomy is a promising treatment strategy for cases of VA dissection resistant to intravenous rt-PA thrombolysis.

Traumatic Vertebral Artery Dissection Without Cervical Spine Injury Treated by Mechanical Thrombectomy

“…Treatment strategy and device selection vary from case to case, although very few cases have been treated with MT. There are reports of patients treated with recombinant tissue plasminogen activator (rt-PA) in combination with MT [ 2 , 3 ], but the present case is unique for several reasons. First, the catheter was inserted into the contralateral VA, while other surgeons chose the ipsilateral side due to concerns that catheter insertion into the contralateral VA would reduce BA blood flow [ 4 , 5 ].…”

“…Traumatic vertebral artery dissection (VAD) is a rare complication of blunt head and neck trauma but is associated with a high rate of cerebral infarction [1]. While mechanical thrombectomy (MT) is widely performed for large vessel occlusion (LVO), there are very few reports of MT use for basilar artery occlusion (BAO) secondary to traumatic VAD [2][3][4][5][6][7]. Further, all previous adult cases of VAD treated using MT were complicated with cervical spine fracture [2,3,5,6], and there are only two published pediatric cases without cervical spine fracture [4,7].…”

“…While mechanical thrombectomy (MT) is widely performed for large vessel occlusion (LVO), there are very few reports of MT use for basilar artery occlusion (BAO) secondary to traumatic VAD [2][3][4][5][6][7]. Further, all previous adult cases of VAD treated using MT were complicated with cervical spine fracture [2,3,5,6], and there are only two published pediatric cases without cervical spine fracture [4,7]. Thus, this is the first report of MT use for BAO due to traumatic VAD in an adult without cervical spine fracture.…”

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

“…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.…”

Acute Placement of Telescoping Open Cell Stents and Thrombectomy for Progressive Symptomatic Vertebrobasilar Dissection: 2-Dimensional Operative Video

“…4 There are reports in the literature documenting the use of stents for reconstruction of occlusions secondary to vertebral artery dissections. [5][6][7][8][9][10][11][12][13][14] We present the case of a 27-year-old woman who presented after a syncopal event with headaches, ptosis, diplopia, and ataxia. Computed tomography angiogram demonstrated left vertebral artery dissection, near occlusion of the basilar artery, and a hypoplastic right vertebral artery.…”