1
|
Minh TL, Chi CT, Hoai NN, Hoang DN, Luu GN, Nhat HND, Hoang LD, Tran TN, Bao LTM. Rescue extracranial vertebral stenting in tandem occlusions: A preliminary Vietnamese study. Interv Neuroradiol 2024:15910199241264342. [PMID: 39034279 DOI: 10.1177/15910199241264342] [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: 07/23/2024] Open
Abstract
BACKGROUND AND PURPOSE The acute vertebrobasilar occlusion associated with the poor prognosis, particularly tandem occlusion. However, few data on the efficacy of the endovascular therapy was indicated in this occlusion. We investigated whether the additional rescue extracranial vertebral stenting improved clinical outcome by modified Rankin scale (mRS) score within 3 months after the procedure. METHODS This was a retrospective analysis of patients with acute posterior tandem occlusion who were treated with rescue extracranial vertebral stenting between December 2020 and January 2024 at our hospital. Clinical, neuroimaging, procedural, and complication data were collected. Primary outcomes included the rate of good outcomes (mRS ≤ 2) at 3-month follow-up. RESULTS Nine patients who underwent rescue extracranial vertebral stenting in posterior circulation tandem occlusions were enrolled in the study. All patients were achieved the successful recanalization (mTICI ≥ 2b). Of Dotter technique in the "distal-to-proximal" approach, Diagnostic-Dotter made up 66.7%. Five patients (55.6%) with good outcome (mRS ≤ 2) at 3 months, and 1 patient (11.1%) underwent suboccipital decompressive craniectomy due to the malignant cerebellar infarction. CONCLUSION Our study suggests that despite the small series with posterior tandem occlusions, the rescue extracranial vertebral stenting could be an important alternative treatment followed by mechanical thrombectomy.
Collapse
Affiliation(s)
- Thang Le Minh
- DSA Unit, Can Tho S.I.S General Hospital, Can Tho City, Vietnam
| | - Cuong Tran Chi
- DSA Unit, Can Tho S.I.S General Hospital, Can Tho City, Vietnam
| | - Nam Nguyen Hoai
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dinh Nguyen Hoang
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | | | - Tran Nguyen Tran
- Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Luan Tran Minh Bao
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Shang X, Pan L, Xu Y, Guo Y, Yang K, Yang Q, Zhou Z. Effect of endovascular treatment on patients with basilar artery occlusion presenting with different pathologic mechanisms: a systematic review and meta-analysis. J Thromb Thrombolysis 2024; 57:124-131. [PMID: 37605064 DOI: 10.1007/s11239-023-02884-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms. METHODS Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms. RESULTS A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms. CONCLUSION Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.
Collapse
Affiliation(s)
- Xianjin Shang
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China.
| | - Liying Pan
- Department of Neurology, Longyan First Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Youqing Xu
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Yapeng Guo
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Ke Yang
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| |
Collapse
|
4
|
Ahmed RA, Dmytriw AA, Patel AB, Stapleton CJ, Vranic JE, Rabinov JD, Leslie-Mazwi TM, Rost NS, Hirsch JA, Regenhardt RW. Basilar artery occlusion: A review of clinicoradiologic features, treatment selection, and endovascular techniques. Interv Neuroradiol 2023; 29:748-758. [PMID: 35695210 PMCID: PMC10680956 DOI: 10.1177/15910199221106049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/17/2022] [Accepted: 05/15/2022] [Indexed: 12/20/2022] Open
Abstract
Basilar artery occlusion (BAO) is an infrequent but often fatal subtype of stroke. Predicting outcomes and selecting patients for endovascular therapy (EVT) remains challenging. Advances in neuroimaging and the development of prognostic scoring systems have augmented clinical decision-making over time. Recent randomized trials, BEST (Basilar Artery Occlusion Endovascular Intervention vs. Standard Medical Treatment), BASICS (Basilar Artery International Cooperation Study), BAOCHE (Basilar Artery Occlusion CHinese Endovascular Trial) and ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion), compared EVT and medical management for patients with BAO. These trials yielded mixed results. The former two suggested unclear benefit while the latter two supported a benefit of EVT. While all had limitations, most providers agree caution should be exercised when excluding patients from EVT who may stand to benefit. Further studies are therefore needed to determine the effectiveness, safety, selection criteria, and optimal technical approach for EVT among patients with BAO. Hyperacute-phase advanced imaging can offer several benefits to aid decision making. It is reasonable to exclude patients with low National Institutes of Health Stroke Scale (NIHSS), large imaging-proven cores, and evidence of perforator occlusion by branch atheromatous disease. Herein, we review the clinical presentation, imaging work-up, treatments, and clinical outcomes for BAO, while highlighting knowledge gaps in treatment selection and technique.
Collapse
Affiliation(s)
- Rashid A Ahmed
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam A Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin E Vranic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James D Rabinov
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thabele M Leslie-Mazwi
- Department of Neurology, Neurosciences Institute, University of Washington, Seattle, WA, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Kwon H, Lee D, Lee DH, Suh DC, Kwon SU, Kang DW, Kim JS. Etiology-Related Outcome of Endovascular Therapy in Posterior Circulation Stroke Compared to Anterior Circulation Stroke. J Stroke 2022; 24:245-255. [PMID: 35677979 PMCID: PMC9194548 DOI: 10.5853/jos.2022.01095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose We investigated the impact of stroke etiology on the endovascular treatment (EVT) procedure and clinical outcome of posterior circulation stroke (PCS) patients with EVT compared to anterior circulation stroke (ACS) patients.
Methods We retrospectively analyzed ischemic stroke patients who underwent EVT between January 2012 and December 2020. Enrolled ACS and PCS patients were compared according to etiologies (intracranial arterial steno-occlusion [ICAS-O], artery-to-artery embolic occlusion [AT-O], and cardioembolic occlusion [CA-O]). EVT procedure and favorable clinical outcomes at 3 months (modified Rankin Scale 0–2) were compared between the ACS and PCS groups for each etiology.
Results We included 419 patients (ACS, 346; PCS, 73) including 88 ICAS-O (ACS, 67; PCS, 21), 66 AT-O (ACS, 50; PCS, 16), and 265 CA-O (ACS, 229; PCS, 36) patients in the study. The onset-to-recanalization time was longer in the PCS group than in the ACS group (median 628.0 minutes vs. 421.0 minutes, P=0.01). In CA-O patients, the door-to-puncture time was longer, whereas the puncture-to-recanalization time was shorter in the PCS group than in the ACS group. The proportions of successful recanalization and favorable clinical outcomes were similar between the ACS and PCS groups for all three etiologies. Low baseline National Institutes of Health Stroke Scale (NIHSS) scores and absence of intracerebral hemorrhage at follow-up imaging were associated with favorable clinical outcomes in both groups, whereas successful recanalization (odds ratio, 11.74; 95% confidence interval, 2.60 to 52.94; P=0.001) was only associated in the ACS group.
Conclusions The proportions of successful recanalization and favorable clinical outcomes were similar among all three etiologies between PCS and ACS patients who underwent EVT. Initial baseline NIHSS score and absence of hemorrhagic transformation were related to favorable outcomes in the PCS and ACS groups, whereas successful recanalization was related to favorable outcomes only in the ACS group.
Collapse
Affiliation(s)
- Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongwhane Lee
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeugbu, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong S. Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence: Jong S. Kim Department of Neurology, Stroke Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3442 Fax: +82-2-474-4691 E-mail:
| |
Collapse
|
7
|
Lee SJ, Hong JM, Kim JS, Lee JS. Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy. J Stroke 2022; 24:207-223. [PMID: 35677976 PMCID: PMC9194547 DOI: 10.5853/jos.2022.00941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/20/2022] [Indexed: 11/11/2022] Open
Abstract
The efficacy of endovascular treatment (EVT) in patients with posterior circulation stroke has not been proven. Two recent randomized controlled trials failed to show improved functional outcomes after EVT for posterior circulation stroke (PC-EVT). However, promising results for two additional randomized controlled trials have also been presented at a recent conference. Studies have shown that patients undergoing PC-EVT had a higher rate of futile recanalization than those undergoing EVT for anterior circulation stroke. These findings call for further identification of prognostic factors beyond recanalization. The significance of baseline clinical severity, infarct volume, collaterals, time metrics, core-penumbra mismatch, and methods to accurately measure these parameters are discussed. Furthermore, their interplay on EVT outcomes and the potential to individualize patient selection for PC-EVT are reviewed. We also discuss technical considerations for improving the treatment efficacy of PC-EVT.
Collapse
Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jong S. Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
- Correspondence: Jin Soo Lee Department of Neurology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5175 Fax: +82-31-219-5178 E-mail:
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Takikawa K, Doijiri R, Ohyama A, Sonoda T, Yamazaki N, Sato M, Yokosawa M, Takahashi K, Sugawara T, Kimura N. Tandem Lesions of the Vertebrobasilar System Treated by Thrombectomy and Vertebral Artery Stenting: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:327-334. [PMID: 37501893 PMCID: PMC10370541 DOI: 10.5797/jnet.cr.2021-0050] [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: 03/30/2021] [Accepted: 08/17/2021] [Indexed: 07/29/2023]
Abstract
Objective There are few reports on endovascular treatment of tandem lesions in the posterior circulation and no consensus on treatment strategies has been reached. We report a case of tandem lesions of basilar artery occlusion and vertebral artery stenosis treated by thrombectomy and vertebral artery stenting. Case Presentation We present the case of a 73-year-old man who developed consciousness disorder and tetraplegia. Head and neck CTA revealed tandem left vertebral artery stenosis and basilar artery occlusion. The patient was treated using a reverse technique, which involves performing thrombectomy first and then vertebral artery stenting, along with Carotid Guardwire PS. Postoperative impairment of consciousness and improvement of tetraplegia were achieved. Conclusion The reverse technique combined with Carotid Guardwire PS may be a useful treatment strategy for tandem lesions in the posterior circulation.
Collapse
Affiliation(s)
- Kohei Takikawa
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Ryosuke Doijiri
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Ayane Ohyama
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Takuji Sonoda
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Naoya Yamazaki
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Mitsunobu Sato
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Michiko Yokosawa
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Ken Takahashi
- Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Takayuki Sugawara
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Naoto Kimura
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| |
Collapse
|
10
|
Filep RC, Marginean L, Stoian A, Bajko Z. Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review). Exp Ther Med 2021; 22:954. [PMID: 34335896 PMCID: PMC8290397 DOI: 10.3892/etm.2021.10386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Acute ischemic stroke treatment has been revolutionized by the addition of mechanical and aspiration thrombectomy. Randomized controlled trials have proven beyond doubt, the substantial clinical impact of endovascular interventions in anterior circulation territory strokes. Unfortunately, patients with vertebrobasilar ischemic stroke could not be included in these early trials due to inherent clinical, radiological, and prognostic particularities of posterior circulation ischemia; thus, indications for the treatment of posterior fossa strokes and basilar artery occlusion (BAO) are mainly based on retrospective studies and registries. BAO carries high morbidity and mortality, despite the new improvements in endovascular therapy. Identifying patients who will likely benefit from invasive treatment and have a good clinical outcome resides in discovering clinical, biological, or imaging markers, that have prognostic implications. Such imaging markers have been described, especially in the last decade. Hyperdense Basilar Artery Sign (HDBA), Posterior Circulations-Alberta Stroke Program Early CT Score (pc-ASPECTS), Pons-Midbrain Index (PMI), Posterior Circulation Collateral Score (pc-CS), Posterior Circulation CT Angiography Score (pc-CTA), and Basilar Artery on CT Prognostic Score (BATMAN), are computed tomography (CT) markers with properties that can aid the diagnosis of BAO and can independently predict clinical outcome. This paper aims to present a comprehensive review of these imaging signs to have a thorough understanding of their diagnostic and prognostic attributes.
Collapse
Affiliation(s)
- Rares Cristian Filep
- PhD School of Medicine, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Lucian Marginean
- PhD School of Medicine, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| |
Collapse
|
11
|
Gao F, Zheng H, Guo X, Sun X, Miao Z. A novel angiographic classification for the endovascular recanalization of symptomatic nonacute extracranial vertebral artery occlusion. J Neurointerv Surg 2021; 14:210-214. [PMID: 33722973 DOI: 10.1136/neurintsurg-2021-017283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND There remains major uncertainty regarding the optimal therapy for symptomatic nonacute extracranial vertebral artery occlusion (EVAO). Endovascular recanalization for EVAO is technically challenging, and limited data are available. This research aimed to report a multicenter clinical experience of endovascular recanalization for symptomatic nonacute EVAO and establish a novel angiographic classification. METHODS From June 2011 to December 2019, 50 symptomatic nonacute EVAO patients treated with endovascular recanalization in three regional referral stroke centers were retrospectively analyzed. All patients were categorized into four groups based on the angiographic classification. The rates of technical success, periprocedural complications, any stroke or death within 1 month, and follow-up data were assessed. RESULTS The rates of technical success, periprocedural complications, and any stroke or death within 1 month were 86.0% (43/50), 12.0% (6/50), and 4.0% (2/50), respectively. The recanalization rates gradually decreased from Type A to Type D (100%, 94.7%, 80%, and 63.6%, respectively; P=0.007). The EVAO patients in the Type A group with tapered stump and short-segment occlusions showed excellent recanalization effects, with 100% technical success rates and no complications. Conversely, the lowest recanalization rate of 63.6% (7/11) and the highest periprocedural complication rate of 27.3% (3/11) were observed for the Type D group. CONCLUSIONS Endovascular recanalization for symptomatic nonacute EVAO is technically feasible, especially Type A EVAO patients, which can provide an alternative treatment option for recurrent vertebrobasilar ischemia despite optimal medical therapy. The angiographic categorization established in this study is conducive to the selection of suitable patients prior to treatment decision.
Collapse
Affiliation(s)
- Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Hongbo Zheng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xu Guo
- Department of Interventional Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| |
Collapse
|
12
|
Successful recanalization after stenting in acute basilar occlusion from vertebral V2 dissection: A telescoping stents technique with long term follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Mizowaki T, Fujita A, Inoue S, Kurihara E. Endovascular Treatment for Vertebrobasilar Artery Tandem Occlusion Beyond 24 Hours From Onset of Stroke-Case Report. Vasc Endovascular Surg 2020; 55:77-80. [PMID: 32869715 DOI: 10.1177/1538574420953953] [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: 11/17/2022]
Abstract
We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.
Collapse
Affiliation(s)
- Takashi Mizowaki
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, 12885Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Satoshi Inoue
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Eiji Kurihara
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| |
Collapse
|
15
|
Carotid Blowout Management in the Endovascular Era. World Neurosurg 2020; 141:e1010-e1016. [PMID: 32599207 DOI: 10.1016/j.wneu.2020.06.151] [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: 05/01/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer, and its therapy is associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we report outcomes of emergent endovascular intervention for CBS. METHODS We conducted a retrospective analysis of a prospectively maintained neurovascular database and identified 38 consecutive endovascular procedures for CBS from 2008-2019 at our institution. Data collection was performed on patient demographics, type of cancer, previous cancer treatments, type of CBS, location of bleed, diagnostic workup, endovascular treatment, and procedural outcomes and complications. RESULTS A total of 38 consecutive endovascular procedures for CBS were performed from 2008-2019 at our single academic institution. Technical success was achieved in 100% of endovascular procedures. Procedural stroke occurred in 1 (2.6%) procedure, procedural mortality occurred in 1 (2.6%) procedure, recurrent CBS occurred in 4 (10.5%) procedures, and fatal rehemorrhage occurred in 1 (2.6%) procedure. Regarding secondary outcomes, delayed stroke/transient ischemic attack occurred in 1 (2.6%) procedure, whereas there were no cases of delayed infectious complications. CONCLUSIONS The endovascular treatment of CBS is safe and effective with relatively low rates of morbidity and mortality compared with other currently available treatment modalities. However, the overall rate of complications demands attention and sheds light on the need for further improvement in management.
Collapse
|
16
|
Baik SH, Jung C, Kim BM, Kim DJ. Mechanical Thrombectomy for Tandem Vertebrobasilar Stroke: Characteristics and Treatment Outcome. Stroke 2020; 51:1883-1885. [PMID: 32404041 DOI: 10.1161/strokeaha.120.029503] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Tandem vertebrobasilar strokes are not well-known causes of posterior circulation stroke. The purpose of this study was to investigate the characteristics and outcome of mechanical thrombectomy in patients with tandem vertebrobasilar stroke. Methods- Acute basilar artery occlusion patients with tandem vertebral artery (VA) stenosis/occlusion who underwent mechanical thrombectomy were retrospectively analyzed. Concomitant tandem VA steno-occlusion was defined as severe stenosis/occlusion of the extracranial VA with impaired flow. Clinical/angiographic characteristics, recanalization rate, procedure time, and clinical outcome were evaluated with comparisons according to the treatment strategy. Results- Tandem vertebrobasilar occlusion was identified in 24.6% (55 of 224) of the acute basilar artery occlusion patients. Overall successful recanalization and good clinical outcome was achieved in 87.2% (48 of 55) and 30.9% (17 of 55) of the patients. There were no significant differences in procedure time, recanalization rate, and clinical outcome in comparisons of the VA access route selection or angioplasty of the tandem VA lesion. Two patients developed short-term recurrent basilar artery occlusion when angioplasty of the tandem VA lesion was not performed. Good clinical outcome was more likely with lower baseline National Institutes of Health Stroke Scale score (odds ratio, 0.87 [95% CI, 0.787-0.961]; P=0.006) and short onset-to-recanalization time (odds ratio, 0.993 [95% CI, 0.987-0.999]; P=0.03). Conclusions- Tandem vertebrobasilar occlusion may be a frequent pathological mechanism of posterior circulation stroke. Good outcome may be achieved by strategic choice of the access route and selective angioplasty of the tandem VA lesion.
Collapse
Affiliation(s)
- Sung Hyun Baik
- From the Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea (S.H.B., C.J.).,Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (S.H.B., B.M.K., D.J.K.)
| | - Cheolkyu Jung
- From the Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea (S.H.B., C.J.)
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (S.H.B., B.M.K., D.J.K.)
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (S.H.B., B.M.K., D.J.K.)
| |
Collapse
|