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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.
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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
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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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3
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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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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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Khilchuk AA, Shcherbak SG, Gukov KD, Vlasenko SV. Delayed reperfusion therapy for ischemic stroke tandem occlusion with subsequent secondary prophylaxis of cerebral ischemic events: A case report and literature review. Radiol Case Rep 2021; 16:3708-3720. [PMID: 34630806 PMCID: PMC8493513 DOI: 10.1016/j.radcr.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 12/05/2022] Open
Abstract
Mechanical thrombectomy is currently the gold standard treatment of large vessel occlusions, especially in anterior circulation acute ischemic stroke. At the same time, the problem of tandem occlusions seems especially important since most of the major clinical mechanical thrombectomy studies did not specifically evaluate patients with concomitant extracranial occlusions or critical stenoses. To date, there is no universally accepted optimal treatment strategy for such tandem lesions in acute ischemic stroke: it remains unclear which lesion – intracranial or extracranial – should be treated first. The selected reperfusion method should be based on the patients’ individual characteristics, data from non-invasive radiologic studies, and the stroke team experience. We present a case of successful reperfusion therapy of acute tandem occlusion of the right internal carotid artery, followed by contralateral carotid artery stenting in a patient with stenosing extracranial atherosclerosis.
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Affiliation(s)
- Anton A Khilchuk
- Interventional Radiology Department, City Hospital #40, 9 Borisova str., Sestroretsk, Saint Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint Petersburg, Russian Federation
| | - Sergey G Shcherbak
- Medical Faculty, Saint-Petersburg State University, Saint Petersburg, Russian Federation
| | - Kirill D Gukov
- Interventional Radiology Department, City Hospital #40, 9 Borisova str., Sestroretsk, Saint Petersburg 197706, Russian Federation
| | - Sergey V Vlasenko
- Interventional Radiology Department, City Hospital #40, 9 Borisova str., Sestroretsk, Saint Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint Petersburg, Russian Federation
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7
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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.
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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
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8
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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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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.
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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
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10
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Weinberg JH, Sweid A, Sajja K, Abbas R, Asada A, Kozak O, Mackenzie L, Choe H, Gooch MR, Herial N, Tjoumakaris S, Zarzour H, Rosenwasser RH, Jabbour P. Posterior circulation tandem occlusions: Classification and techniques. Clin Neurol Neurosurg 2020; 198:106154. [PMID: 32829201 DOI: 10.1016/j.clineuro.2020.106154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Posterior circulation tandem occlusions are poorly characterized in current literature. Data regarding endovascular approaches and outcomes in this patient subgroup is extremely limited. METHODS We conducted a retrospective analysis of a prospectively maintained database and identified 17 patients with posterior circulation tandem occlusions who underwent mechanical thrombectomy between 2014 and 2019. RESULTS Of 17 patients with posterior circulation tandem occlusion, the mean age was 55.76 ± 11.8 with 35.3% female. The mean NIHSS score on presentation was 17.2 ± 9.2. Tissue plasminogen activator was administered in 7 (41.2%) patients, stent-retrievers alone were used in 2 (11.8%), aspiration catheters alone were used in 2 (11.8%), a combination was used 12 (70.6%), and a self-expandable stent in 5 (29.4%). The mean number of device passes was 2.24 ± 2.02, recanalization failure occurred in 4 (23.5%) patients, the mean time from stroke onset to puncture was 6.9 ± 2.4 h, and the mean time from puncture to recanalization was 59.3 ± 26.6 min. Postprocedural symptomatic ICH occurred in 1 (5.9 %) patient, periprocedural ICH/SAH occurred in 2 (11.8%), periprocedural distal emboli occurred in 0 (0%), periprocedural vessel dissection occurred in 1 (5.9%), and periprocedural vessel perforation occurred in 1 (5.9%) patient. TICI score>2b was achieved in 13 (76.5%) patients. An improvement in NIHSS>3 at discharge occurred in 10 (58.8%) patients, and good outcomes (mRS score < 2) occurred in 7 (41.2%). The mean length of stay was 11.6 ± 12.2 days, and the mortality rate was 41.2%. CONCLUSION Endovascular intervention with mechanical thrombectomy is safe and feasible in patients with posterior circulation tandem occlusions.
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Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Kalyan Sajja
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Rawad Abbas
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.
| | - Ashlee Asada
- Drexel University, College of Medicine, Drexel University, Philadelphia, PA, USA.
| | - Osman Kozak
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Larami Mackenzie
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Hana Choe
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia 19107, PA USA.
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11
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Xu C, Wang F, Lv P, Zhang X, Tang G. Endovascular treatment combined with vertebral artery endarterectomy for patients with acute tandem vertebrobasilar artery occlusion. J Clin Neurosci 2020; 79:21-29. [PMID: 33070898 DOI: 10.1016/j.jocn.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of endovascular treatment combined with vertebral artery endarterectomy in patients with acute tandem vertebrobasilar artery occlusion. METHODS From April 2017 to March 2019, three patients with acute basilar artery occlusion combined with ostial vertebral occlusion in our institution were enrolled in the study. They underwent endovascular treatment combined with vertebral artery endarterectomy. The clinical, technical and functional outcomes of the patients were retrospectively analysed. RESULTS All three patients in the study underwent complete recanalization. The modified Thrombolysis in Cerebral Infarction (mTICI) grade was 2b/3 in all patients. The modified Rankin Scale (mRS) score was 0-2 for the three patients at 3 months. Follow-up CT scans revealed no cerebral haemorrhage, and no patients died during follow-up. All patients achieved good clinical outcomes after the combined treatment. CONCLUSION Endovascular treatment combined with vertebral artery endarterectomy is a feasible method to treat patients with acute basilar artery occlusion combined with ostial vertebral occlusion, especially when the guidewire cannot pass through the ostium of the dominant vertebral artery occlusion.
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Affiliation(s)
- Chuan Xu
- Department of Radiology, Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University, No. 301 Yanchang Road, Shanghai 200072, China
| | - Fuan Wang
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China
| | - Penghua Lv
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Clinical Hospital of Nanjing Medical University, No. 98 Nantong Road, Yangzhou 225001, Jiangsu, China
| | - Xicheng Zhang
- Department of Vascular Surgery, Northern Jiangsu People's Hospital, Clinical Hospital of Nanjing Medical University, No. 98 Nantong Road, Yangzhou 225001, Jiangsu, China
| | - Guangyu Tang
- Department of Radiology, Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University, No. 301 Yanchang Road, Shanghai 200072, China.
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12
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The "distal-to-proximal" strategy for the treatment of posterior circulation tandem occlusions: a single-centre experience. Neuroradiology 2020; 62:867-876. [PMID: 32242265 DOI: 10.1007/s00234-020-02412-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Data on posterior circulation tandem occlusions in acute ischemic stroke are scarce: recognition may be challenging and little is known about optimal treatment strategy. We report our endovascular treatment strategy for posterior circulation tandem occlusion. METHODS Consecutive patients with posterior circulation tandem occlusions in our centre were enrolled retrospectively. The preferred strategy was "distal-to-proximal" strategy, which means opening the distal occlusion first followed by treatment of the proximal pathology. The imaging characteristics, treatment strategy, clinical outcomes, and complications of patients with posterior circulation tandem occlusions were analyzed. RESULTS In total, 21 patients with posterior circulation tandem occlusions were enrolled in the study, which accounted for 23.6% of patients with posterior circulation stroke in our centre. The mean age was 60 years (range 32 to 80), and median pre-procedure NIHSS score was 28 (interquartile range: 13-31). Eighteen patients (85.7%) had vertebrobasilar artery tandem occlusions and 3 (14.3%) had basilar artery to basilar artery tandem occlusions. All distal occlusions were successfully recanalized (modified TICI 2b/3). Two (9.5%) of the proximal lesions were not treated. A total of 57.1% of the patients had stents implanted on the proximal occlusions. The rate of mRS 0-3 at 3 months was 57.1% and the mortality rate was 19.0%. CONCLUSION In patients with acute ischaemic stroke caused by posterior circulation tandem occlusions, we favor "distal-to-proximal" strategy based on the positive results in this small series. Nevertheless, a more extensive study is required to explore the optimal treatment strategy further.
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Gross BA, Jadhav AP, Jankowitz BT, Jovin TG. Recanalization of Tandem Vertebrobasilar Occlusions with Contralateral Vertebral Occlusion or Hypoplasia via either Direct Passage or the SHERPA Technique. INTERVENTIONAL NEUROLOGY 2020; 8:13-19. [PMID: 32231691 DOI: 10.1159/000493198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022]
Abstract
Introduction Tandem vertebral ostial disease with acute intracranial vertebrobasilar occlusion with contralateral vertebral occlusion or hypoplasia presents a unique challenge to the interventionalist. Methods The authors queried a prospectively maintained institutional endovascular database from August 2013 to June 2018 for cases of endovascularly treated acute tandem vertebrobasilar occlusions in the presence of contralateral vertebral occlusive disease or hypoplasia. Demographic and presentation data, the technique, results, and clinical outcome were extracted. Results Tandem recanalization was attempted and achieved in 5 patients with a thrombolysis in cerebral infarction (TICI) 3 result in 4 patients and a TICI 2c result in 1 patient. To facilitate effective manual aspiration thrombectomy for the tandem basilar occlusion, performed in all cases in 1 or 2 passes, the Neuron<sup>TM</sup> MAX sheath was advanced into the V2 after Dotter or balloon angioplasty of the diseased origin. In cases where the origin cannot be crossed/visualized, the Synchro Helper to Evaluate via Retrograde Passage an Arterial origin (SHERPA) technique, entailing the passage of a microwire retrograde via the hypoplastic contralateral vertebral artery was utilized to delineate the vertebral ostium (n = 2 cases). All but 1 patient had substantial improvement in the National Institutes of Health Stroke Scale score after the procedure. Conclusion Recanalization of tandem vertebrobasilar occlusions with contralateral occlusion or hypoplasia is feasible. Intracranial recanalization is facilitated by the passage of a long 6F sheath into V2, and retrograde delineation of an occluded vertebral origin with a microwire may serve as a crucial adjunct.
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Affiliation(s)
- Bradley A Gross
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashutosh P Jadhav
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian T Jankowitz
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Kojima I, Shimozato R, Hayashi M, Iijima A. Treatment Strategies for Basilar Top Syndrome Caused by Acute Vertebral Artery Occlusion. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:215-221. [PMID: 37501701 PMCID: PMC10370650 DOI: 10.5797/jnet.cr.2019-0024] [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: 04/14/2019] [Accepted: 03/03/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a patient with basilar artery embolism caused by vertebral artery stenosis who was successfully treated using simultaneous percutaneous transluminal angioplasty (PTA) and mechanical thrombectomy. Case Presentation A 64-year-old male, who had undergone medical treatment for cerebellum infarction at another hospital, was referred to our hospital due to disturbance of consciousness. Angiography revealed acute occlusion of the first part of the right vertebral artery and an embolism of the top of basilar artery. After performing PTA to create an approach route for the embolism, we collected it using a clot recovering device. The postoperative course was good, and the patient was discharged with mild ataxia and dysarthria. Conclusion We report the successful treatment of progressive cerebral infarction of the posterior circulation with revascularization 30 hours after symptom onset. Unlike the anterior circulation, the posterior circulation consists of smaller arteries and fewer collateral arteries, making it vulnerable to ischemic attack. Therefore, shortening the time until treatment may improve the outcome.
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Affiliation(s)
- Iori Kojima
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Rin Shimozato
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Mototaka Hayashi
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Akira Iijima
- Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
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15
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Thrombectomy in acute vertebrobasilar occlusion: a single-centre experience. Neuroradiology 2020; 62:723-731. [DOI: 10.1007/s00234-020-02376-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
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16
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Piechowiak EI, Kaesmacher J, Zibold F, Dobrocky T, Mosimann PJ, Jung S, Fischer U, Arnold M, Bellwald S, Heldner MR, Gralla J, Mordasini P. Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion. J Neurointerv Surg 2019; 12:25-29. [DOI: 10.1136/neurintsurg-2019-014825] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 11/03/2022]
Abstract
Background and purposeAcute basilar artery occlusion (BAO) is a devastating disease with a high rate of mortality and morbidity, and early recanalization is crucial to achieve a good prognosis. The best treatment strategy for BAO combined with a proximal stenosis (tandem occlusion) is not yet clear. Our study aimed to evaluate whether and how vertebrobasilar tandem occlusions can be treated effectively and safely compared with isolated BAO.Materials and methodsFifty-two patients with acute vertebrobasilar occlusive stroke treated with mechanical thrombectomy were identified in a prospective database from March 2010 to September 2016. We retrospectively analysed the clinical, technical, and functional outcomes of the patients.ResultsOf the 52 patients, 15 presented with a tandem occlusion, 14 with a single intracranial occlusion due to an underlying stenosis, and 23 with a single embolic BAO. Successful recanalization was achieved in all of the patients with tandem occlusions (modified Thrombolysis in Cranial Infarction 2b/3) and in 35 of 37 patients with a single BAO (with and without stenosis). A favourable outcome was achieved (modified Rankin Scale ≤2) in 8 of the 15 patients with a tandem occlusion compared with 4 of the 14 patients with a single BAO with underlying stenosis and 5 of the 23 patients with isolated embolic BAO (p=0.18).ConclusionsWe suggest that endovascular treatment of vertebrobasilar tandem occlusions is safe and feasible, with a high rate of good outcome.
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