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Klail T, Piechowiak EI, Krug N, Maegerlein C, Maus V, Fischer S, Lobsien D, Pielenz D, Styczen H, Deuschl C, Thormann M, Diamandis E, Heldner MR, Kaesmacher J, Mordasini P. Endovascular revascularization of vertebrobasilar tandem occlusions in comparison to isolated basilar artery occlusions: A multi-center experience. Interv Neuroradiol 2024:15910199241240045. [PMID: 38576395 DOI: 10.1177/15910199241240045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Acute basilar artery occlusion (BAO) is a severe disease that is associated with an 85% mortality rate if untreated. Several studies have analyzed the use of mechanical thrombectomy (MT) in the different scenarios of BAO. However, the results remain conflicting and the role of MT as standard of care for vertebrobasilar tandem occlusions (VBTO) has not been confirmed. Our goal was to assess technical feasibility, safety, and functional outcome of endovascular treatment of VBTO in comparison to isolated BAO (IBAO). METHODS We retrospectively reviewed all prospectively collected patients with acute BAO from six tertiary centers between September 2016 and November 2021. Patients were subsequently divided into two groups: VBTO and IBAO. Baseline data, procedural details, and outcomes were compared between groups. RESULTS A total of 190 patients were included, 55 presenting with a VBTO and 135 with IBAO. Successful recanalization was equally common in both groups (89.1% and 86.0%). Rates of favorable functional outcome (modified Rankin Scale: 0-2) were higher in patients with VBTO compared to IBAO (36.4% vs. 25.2%, p = 0.048) and mortality was lower (29.1% vs. 33.3%). However, these associations faded after adjustment for confounders (adjusted odds ratio [aOR] 0.86, 95% CI 0.35-2.05; aOR 0.93, 95% CI 0.35-2.45). Rates of symptomatic intracranial hemorrhage did not differ between the groups (VBTO: 7.3% vs. IBAO: 4.2%; p = 0.496). CONCLUSION Endovascular treatment of VBTO is technically feasible and safe with similar rates of successful recanalization, favorable functional outcome, and mortality to those in patients with IBAO.
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Affiliation(s)
- Tomas Klail
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eike I Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nadja Krug
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Christian Maegerlein
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Volker Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
- Klinik für Radiologie und Neuroradiologie, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Sebastian Fischer
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Daniel Pielenz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Maximilian Thormann
- University Clinic for Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Elie Diamandis
- University Clinic for Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of St Gallen, St Gallen, Switzerland
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Liang K, Wang B, Zhao L, Cao Y, Jiang L, Liu Q, Liu S, Shi H, Jia Z. Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority. Interv Neuroradiol 2023; 29:570-576. [PMID: 35876354 PMCID: PMC10549717 DOI: 10.1177/15910199221111710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Kun Liang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Bin Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Linbo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Yuezhou Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Lei Jiang
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Qianghui Liu
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Zhenyu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
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Imaging mismatch between Alberta Stroke Program Early CT Score and perfusion imaging may be a good variable for endovascular treatment. Eur Radiol 2023; 33:2629-2637. [PMID: 36502458 DOI: 10.1007/s00330-022-09273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/18/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Some patients with acute large vessel occlusion (LVO) presented imaging mismatch, low Alberta Stroke Program Early CT Score (ASPECTS) with small ischemic core, or high ASPECTS with large ischemic core. The study was designed to explore whether patients with imaging mismatch could benefit from endovascular treatment (EVT). METHODS We retrospectively reviewed patients with LVO treated with EVT in our center from March 2018 to Jul 2020. Patients were divided into three groups, imaging mismatch, small ischemic core, and large ischemic core groups. Pooled analyses based on stroke onset to treatment time were done. Multivariate regression analysis was performed to explore the factors for good outcomes. RESULTS Sixty-eight of 419 patients with LVO presented with imaging mismatch, and 35 of those (51%) achieved good outcomes after EVT at 90-day. No significant differences were noted in good outcomes and symptomatic intracranial hemorrhage (sICH) between patients with imaging mismatch and small ischemic core. Compared with large ischemic core, patients with imaging mismatch presented lower risk of sICH (95% confidence interval (CI) 0.04-0.75, p = 0.011) within 6 h and higher proportion of good outcomes (95% CI 0.37-0.82, p = 0.002) at 6 to 24 h. Baseline NIHSS (odds ratio (OR) = 0.91, 95% CI 0.88-0.95)), ASPECTS (OR = 1.14, 95% CI 1.01-1.29), ischemic core (OR = 0.99, 95% CI 0.98-1.00), and sICH (OR = 61.61, 95% CI 8.09-461.32) were associated with good outcomes. CONCLUSIONS Patients with imaging mismatch treated within 24 h could benefit from EVT and without increasing the risk of sICH. KEY POINTS • Patients with imaging mismatch between ASPECTS and ischemic core could achieve good outcomes after endovascular treatment. • Compared with large ischemic core, patients with imaging mismatch presented lower risk of symptomatic hemorrhage within 6 h and higher proportion of good outcomes within 6-24 h. • Baseline NIHSS score, ASPECTS, ischemic core, and symptomatic intracranial hemorrhage were associated with good outcomes.
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Lei K, Chen W, Cheng Z, Li F, Wang K, Yin M, Zhu X, Guo H, Tu J. Endovascular treatment of acute basilar artery occlusion caused by vertebral artery stump syndrome: A clinical analysis of 37 cases. Heliyon 2023; 9:e14956. [PMID: 37064468 PMCID: PMC10102400 DOI: 10.1016/j.heliyon.2023.e14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Acute basilar artery occlusion (ABAO) caused by vertebral artery stump syndrome (VASS) has a low incidence and is always underestimated. Due to the occlusion of the origin of the vertebral artery (VA), it is often combined with basilar artery (BA) endovascular diseases or non-dominant contralateral vertebral artery, making the endovascular treatment (EVT) challenging to implement. Objective This article focuses on whether EVT and two interventional route options could bring clinical benefits to this group of patients: basilar artery thrombectomy through the occluded lateral vertebral artery and implementing revascularization of the occluded vertebral artery (dirty-road-path); thrombectomy through the non-occluded lateral vertebral artery (clean-road-path). Methods We collected six cases of acute embolic basilar artery occlusion (ABAO) due to VASS from January 2020 to December 2021 at our hospital and retrospectively analyzed 31 patients previously reported in the literature and applied statistical analysis to investigate the treatment options and clinical prognosis of these patients. Results The clean-road-path surgical protocol was applied in 4 of 37 patients, the dirty-road-path protocol was applied in 29 patients, and 4 patients did not recanalized the basilar artery. By statistical analysis we found that successful recanalization of the basilar artery was clinically significant in reducing the modified Rankin Scale (mRS) scores in these patients, the statistical difference in the benefit of the two surgical protocols was negative. There was a significant positive correlation between preoperative National Institute of Health Stroke Scale (NIHSS) and postoperative 90-day mRS scores. Conclusion Endovascular treatment can benefit patients with ABAO due to VASS, and patients with higher preoperative NIHSS scores are more vulnerable to getting a poor prognosis. Comparison between the two endovascular options did not yield statistically significant results, but the dirty-road-path option may be superior to using the clean-road-path.
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Ishikawa K, Endo H, Nomura R, Yamaguchi D, Oka K, Nakamura H. Acute reperfusion therapy via occluded vertebral artery using a guiding sheath for posterior circulation tandem occlusion: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22480. [PMID: 36647256 PMCID: PMC9844521 DOI: 10.3171/case22480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
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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Affiliation(s)
- Kohei Ishikawa
- Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan; and ,Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan
| | - Hideki Endo
- Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan; and ,Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan
| | - Ryota Nomura
- Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan; and ,Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan
| | - Daishi Yamaguchi
- Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan; and ,Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan
| | - Koji Oka
- Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan; and
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan
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Zhang W, Wang S, Li C, Wang Z, Yue F, Zhou J, Song K, Wang C, Wang Y, Shi M. A Case Series and Literature Review of Vertebral Artery Stump Syndrome. Front Neurol 2022; 12:770845. [PMID: 35153978 PMCID: PMC8831726 DOI: 10.3389/fneur.2021.770845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/23/2021] [Indexed: 01/01/2023] Open
Abstract
PurposeStump syndrome refers to cerebral ischaemic symptoms caused by an embolus from a previously occluded ipsilateral artery that occludes a down-stream artery. It can be divided into two types: carotid stump syndrome and vertebral artery stump syndrome (VASS). At present, there is limited clinical experience with VASS. We aimed to propose a more precise diagnostic standard for VASS, and to share our experience with handling this condition.Materials and MethodsWe retrospectively collected data of patients who were treated with endovascular thrombectomy in the stroke centre of the First Hospital of Jilin University from January 2016 to March 2020. After screening patients with posterior-circulation acute ischaemic stroke, we selected patients who had an acute occlusion of an intracranial artery in the context of a previously occluded ipsilateral vertebral artery origin, as confirmed by digital subtraction angiography.ResultsEleven patients met our inclusion criteria. Nine patients achieved recanalization of both extracranial and intracranial occluded arteries, one patient had modified thrombolysis in cerebral infarction grade 3, and eight patients had grade 2b. Residual stenosis of recanalized intracranial arteries was less than 30% in all cases, while three patients had embolism of distal arteries. No dissection or subarachnoid haemorrhage occurred. Two patients didn't reach vascular recanalization. Among the nine patients with recanalized artery, four had a 90-day modified Rankin Scale score ≤ 3 (favourable outcome), and four patients died; As for the two non-recanalized patients, one had a mRS score of 5 and one died.ConclusionVASS is a clinical syndrome caused by embolic occlusion of a distal intracranial artery occluded ipsilateral extracranial vertebral artery. Antegrade blood flow from the collateral vessels, distal embolic occlusion and mild or no residual stenosis of the occluded intracranial artery after recanalization are notable features of this clinical event. Endovascular thrombectomy may be effective for treating VASS.
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Affiliation(s)
- Wenbin Zhang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Shouchun Wang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Chao Li
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Zhongxiu Wang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Feixue Yue
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Jie Zhou
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangjia Song
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Chao Wang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Yujiao Wang
- Nursing Department, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Mingchao Shi
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
- *Correspondence: Mingchao Shi
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Mahmoud MN, Zaitoun MMA, Abdalla MA. Revascularization of vertebrobasilar tandem occlusions: a meta-analysis. Neuroradiology 2021; 64:637-645. [PMID: 34821947 DOI: 10.1007/s00234-021-02866-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/21/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate the difference in mechanical thrombectomy (MT) outcomes between vertebrobasilar tandem occlusion (VBTO) and isolated basilar artery (BA) occlusion (non-VBTO) and the difference in rates of successful recanalization between the clean-road and dirty-road pathways, in VBTO. METHODS We conducted a meta-analysis after searching PubMed, EMBASE, and Google Scholar databases as of April 2021. We only included adult patients who underwent MT to treat acute ischemic stroke (AIS) due to VBTO, and the following outcomes should be reported: successful recanalization, functional outcome at 90 days, and symptomatic intracerebral hemorrhage (sICH). The main effect size measures were odds ratio and risk difference, and the software used was RevMan 5.4. RESULTS The analysis included 81 VBTO and 324 non-VBTO patients (seven studies). We found no significant difference regarding 3 m functional independence [4 studies: OR = 1.71 (95% CI, 0.54, 5.43), I2 = 75%], 3 m mortality [4 studies: OR = 1.62 (95% CI, 0.62, 4.25), I2 = 66%], sICH [4 studies: OR = 1.71 (95% CI, 0.67, 4.39), I2 = 0%], and successful recanalization [3 studies: OR = 0.81 (95% CI, 0.12, 5.57), I2 = 80%]. A subgroup analysis of 118 VBTO patients (five studies) showed no significant difference in successful recanalization between clean-road and dirty-road pathways [RD = 0.07 (95% CI, - 0.09, 0.24), I2 = 40%]. CONCLUSION The results of this meta-analysis support the use of MT for AIS patients with VBTO. In VBTO patients, none of the clean-road or dirty-road pathways proved to be superior to the other.
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Affiliation(s)
- Mohamed Nabil Mahmoud
- Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shebin El-kom, Menoufia, Egypt.
| | - Mohamed M A Zaitoun
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed A Abdalla
- Neurosurgery Department, St George's University Hospital, Blackshaw Road, London, UK
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Elhorany M, Boulouis G, Hassen WB, Crozier S, Shotar E, Sourour NA, Lenck S, Premat K, Fahed R, Degos V, Elhfnawy AM, Mansour OY, Tag El-Din ESA, Fadel WA, Alamowitch S, Samson Y, Naggara O, Clarençon F. Outcome and recanalization rate of tandem basilar artery occlusion treated by mechanical thrombectomy. J Neuroradiol 2020; 47:404-409. [PMID: 32910987 DOI: 10.1016/j.neurad.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tandem basilar artery occlusions (tBAO) are defined as concomitant basilar artery and extracranial dominant vertebral artery occlusions. The prognosis of such tBAO treated by mechanical thrombectomy (MT) has been scantly reported. The purpose of our study was to compare the safety and effectiveness of MT for patients with tBAO compared to those with non-tandem basilar artery occlusions (ntBAO). PATIENTS AND METHODS Retrospective analysis of a database of patients who underwent MT at two academic centres. All patients treated for BAO were retrieved. Patients with tBAO, defined as a concomitant BAO and extracranial vertebral artery (VA) occlusion or severe stenosis ≥70% (V1 or proximal V2 segment) were compared with patients with ntBAO. RESULTS A total of 15 patients with tBAO and 74 patients with ntBAO were enrolled. Successful reperfusion (modified thrombolysis in cerebral infarction score ≥2b) was obtained in 73.3% versus 90.5% (OR = 0.29, 95%CI: 0.07-1.15), good clinical outcome (3-months modified Rankin scale ≤2) was reached by 26.7% versus 32.4% (OR = 0.76; 95% CI: 0.24-2.63) and mortality at 3-months was 46.7% versus 31% (OR = 1.94; 95%CI: 0.63-6) of patients with tBAO versus ntBAO, respectively. Two patients (13.3%) with tBAO and three (4%) with ntBAO had symptomatic intracranial haemorrhage (OR = 3.64; 95% CI: 0.55-24). CONCLUSION Mechanical thrombectomy for patients with tandem basilar artery occlusion tends to be associated with lower rates of successful reperfusion and good clinical outcome, and higher rate of mortality. Larger multicentre studies are warranted to better precise the proper selection and management of such patients.
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Affiliation(s)
- Mahmoud Elhorany
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Department of Neurology, Faculty of Medicine, Tanta University, Egypt
| | - Grégoire Boulouis
- INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
| | - Wagih Ben Hassen
- INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
| | - Sophie Crozier
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Stephanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Kevin Premat
- Sorbonne University, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Robert Fahed
- Department of Interventional Neuroradiology, Fondation A. de Rothschild, Paris, France
| | - Vincent Degos
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Anaesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Ahmed Mohamed Elhfnawy
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | | | | | - Wael Ahmed Fadel
- Department of Neurology, Faculty of Medicine, Tanta University, Egypt
| | - Sonia Alamowitch
- Sorbonne University, Paris VI University, Paris, France; Department of Vascular Neurology, Saint-Antoine University Hospital, Paris, France
| | - Yves Samson
- Sorbonne University, Paris VI University, Paris, France; Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Naggara
- INSERM-U1266, Interventional Neuroradiology Department, Sainte-Anne Hospital, Paris V University, Paris, France
| | - Frédéric Clarençon
- Sorbonne University, Paris VI University, Paris, France; GRC-14 Biosfast, Paris VI University, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
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