Ultrasound guided V3 segment vertebral artery direct percutaneous puncture for basilar artery mechanical thrombectomy in acute stroke: a technical report

Abstract

SUMMARYA middle aged patient presented with acute ischemic stroke due to basilar artery occlusion. The patient clinically deteriorated despite intravenous thrombolysis and was referred for mechanical thrombectomy. The right vertebral artery was occluded and could not be accessed despite attempting various shaped catheters, even when a radial artery access was used. The left vertebral artery ended in the posterior inferior cerebellar artery. Eventually, ultrasound guided V3 segment vertebral artery direct puncture was successfully done and the procedure was completed. No access related complications were encountered. Direct cervical arterial puncture can be safely used by experienced operators as a last resort in acute stroke cases with difficult access. BACKGROUND

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

“…[1][2][3][4][5] This improvement is reflected in better clinical outcome in studies such as Solitaire With the Intention for Thrombectomy (SWIFT), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO)-2, and Solitaire FR Thrombectomy for Acute Revascularization (STAR). [6][7][8][9] This enthusiasm for newer mechanical devices is tempered by results of Interventional Management of Stroke (IMS) 3, Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke (SYNTHESIS), and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR Rescue) that demonstrate no added advantage of endovascular therapy compared with intravenous tissue-type plasminogen activator (tPA).…”