1
|
Teivāne A, Naļivaiko I, Jurjāns K, Vētra J, Veiss A, Novaša A, Dzelzīte S, Krieviņš D, Miglāne E. Successful Mechanical Thrombectomy for Basilar Artery Occlusion in a Pediatric Patient: A Case Report. Biomedicines 2023; 11:2774. [PMID: 37893148 PMCID: PMC10603831 DOI: 10.3390/biomedicines11102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Studies have shown the benefits of endovascular treatment (EVT) in adult stroke cases, but its application in pediatric stroke remains controversial. Despite evidence of improved outcomes in adults, there are no established recommendations for EVT in children. Conducting individual case reports and case series is vital to understanding its potential advantages and disadvantages in this context. In this case report, a 9-year-old male initially diagnosed with gastroenteritis developed sudden left-sided weakness 1 day after admission. Comprehensive imaging revealed acute ischemia in the cerebellum, indicating a basilar artery thrombus. Urgent endovascular treatment (EVT) was performed 8.5 h after the onset of neurological symptoms, achieving successful revascularization. The patient underwent rehabilitation and was later discharged with improved neurological status. Despite extensive investigations, the stroke's origin remained unknown. After six months, the patient exhibited complete neurological recovery, highlighting the patient's remarkable resilience.
Collapse
Affiliation(s)
- Agnete Teivāne
- Faculty of Residency, Riga Stradins University, LV-1007 Riga, Latvia
- Neurology Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.J.); (J.V.); (A.N.); (E.M.)
| | - Inga Naļivaiko
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (I.N.); (A.V.); (S.D.)
| | - Kristaps Jurjāns
- Neurology Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.J.); (J.V.); (A.N.); (E.M.)
- Department of Neurology and Neurosurgery, Riga Stradins University, LV-1007 Riga, Latvia
- The Red Cross Medical College, Riga Stradins University, LV-1007 Riga, Latvia
| | - Jānis Vētra
- Neurology Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.J.); (J.V.); (A.N.); (E.M.)
- Department of Neurology and Neurosurgery, Riga Stradins University, LV-1007 Riga, Latvia
| | - Andris Veiss
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (I.N.); (A.V.); (S.D.)
| | - Arina Novaša
- Neurology Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.J.); (J.V.); (A.N.); (E.M.)
| | - Sarmīte Dzelzīte
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (I.N.); (A.V.); (S.D.)
| | - Dainis Krieviņš
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
| | - Evija Miglāne
- Neurology Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.J.); (J.V.); (A.N.); (E.M.)
- Department of Neurology and Neurosurgery, Riga Stradins University, LV-1007 Riga, Latvia
| |
Collapse
|
2
|
Zhao G, He X, Liu Y, Zhang L, Li K. Single-center experience of endovascular treatment for patients with progressive posterior circulation cerebral infarction exceeding 24 h. ASIAN BIOMED 2023; 17:64-71. [PMID: 37719319 PMCID: PMC10505061 DOI: 10.2478/abm-2023-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Evidence of endovascular treatment (ET) for patients with progressive infarction of the posterior circulation exceeding 24 h is lacking. Objective To evaluate the efficacy and safety of ET for progressive posterior circulation cerebral infarction. Methods This retrospective study evaluated the ET for 18 patients with posterior circulation infarction caused by vertebrobasilar artery occlusion from July 2017 to November 2018. The conditions of patients worsened despite receiving intravenous thrombolysis or combination therapy with clopidogrel and aspirin. The time from the onset of cerebral infarction to puncture was >24 h. The preoperative National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and related risk factors of patients at 3 months were analyzed postoperatively. Results The preoperative NIHSS score was 10.6 (IQR: 6.5), and the time from onset to puncture was 163.5 ± 144.7 h. Postoperative blood flow was modified thrombolysis in cerebral infarction (mTICI) grade 2b or above. During the follow-up period, 1 patient died of basilar artery re-occlusion and pulmonary infection, and 1 died of postoperative hyperperfusion hemorrhage, with a mortality rate of 11.1% (2/18). No recurrent ischemic events were observed in any of the 16 patients during the 3-month follow-up period. The mean mRS score was 1.3 (IQR: 2.3), and 75% patients (12/16) had an mRS score of 0-2. There were no significant differences in age, gender, clinical characteristics, and stroke subtype between patients with mRS scores ≤2 and >2. Conclusion In patients with progressive posterior circulation cerebral infarction caused by vertebral basilar artery occlusion, ET is effective and safe even if the time from onset to puncture exceeds 24 h.
Collapse
Affiliation(s)
- Guangfeng Zhao
- Department of Encephalopathy, Hainan Province Hospital of Traditional Chinese Medicine, Haikou, Hainan570203, China
| | - Xiongjun He
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| | - Yajie Liu
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| | - Liang Zhang
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| | - Kaifeng Li
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| |
Collapse
|
3
|
Yue C, Deng W, Liu J, Luo X, Miao J, Liu J, Zheng B, Du J, Zhang Y, Yang S, Zi W, Li F. Endovascular treatment in patients with coma that developed secondary to acute basilar artery occlusion. J Neurosurg 2022; 137:1491-1500. [PMID: 35303706 DOI: 10.3171/2022.1.jns212967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of endovascular treatment (EVT) in patients with secondary coma following acute basilar artery occlusion (comatose patients) and to identify the impact of the Glasgow Coma Scale (GCS) score on medical decisions. METHODS Patients from the Endovascular Treatment for Acute Basilar Artery Occlusion study were divided into comatose and noncomatose cohorts. The primary outcome was favorable functional independence (modified Rankin Scale [mRS] scores 0-3). The safety outcome was 90-day mortality. Subgroup analysis was performed to identify populations best suited for EVT. Multivariate logistic regression was used to identify independent predictive factors of clinical outcomes. RESULTS Comatose patients who underwent EVT had more favorable functional outcomes and lower mortality compared with those who underwent standard medical treatment (functional outcomes: 15.98% vs 4.17%; mortality: 62.72% vs 82.29%). Moreover, EVT was associated with better outcomes in the cohort with GCS scores of 6-8 (mRS scores 0-3, 25.33% and mortality, 41.33%) than in the cohort with GCS scores of 3-5. Multivariate analysis indicated that EVT was an independent factor for favorable functional outcomes (adjusted OR 8.921, 95% CI 2.330-34.158) and mortality (adjusted OR 0.189, 95% CI 0.092-0.411) in comatose patients. The initial GCS score was an independent factor for favorable functional outcomes (adjusted OR 1.402, 95% CI 1.115-1.763) and mortality (adjusted OR 0.613, 95% CI 0.499-0.752) in comatose patients with EVT. CONCLUSIONS EVT significantly improved the prognosis of comatose patients, and patients with GCS scores of 6-8 were found to benefit more from EVT than those with GCS scores of 3-5. The initial GCS score was an independent predictive factor for prognosis in comatose patients.
Collapse
Affiliation(s)
- Chengsong Yue
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Deng
- 2Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Juan Liu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaojun Luo
- 3Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Jian Miao
- 4Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Jincheng Liu
- 5Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang, China
| | - Bo Zheng
- 6Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Jie Du
- 7Department of Neurology, Kaizhou District People's Hospital, Chongqing, China
| | - Yuxian Zhang
- 8Department of Neurology, Danzhai County People's Hospital, Danzhai, China; and
| | - Shunyu Yang
- 9Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wenjie Zi
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| |
Collapse
|
4
|
Wu L, Zhang D, Chen J, Sun C, Ji K, Li W, Zhao W, Li C, Wu C, Li M, Wu D, Ji X. Long-term outcome of endovascular therapy for acute basilar artery occlusion. J Cereb Blood Flow Metab 2021; 41:1210-1218. [PMID: 32955959 PMCID: PMC8142131 DOI: 10.1177/0271678x20958587] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The long-term functional outcome of acute basilar artery occlusion (BAO) patients who received modern endovascular therapy (EVT) is unclear. We sought to assess the long-term functional outcome of BAO patients treated with EVT and determine the prognostic factors associated with favorable outcome. We enrolled consecutive BAO patients who received EVT between December 2012 and December 2018 in this observational study. Baseline characteristics and outcomes were presented. Multivariable logistic regression analysis was performed to identify the prognostic factors associated with long-term outcome. Among the 177 BAO patients included in this study, 80 patients (45.2%) obtained favorable outcome and 97 patients (54.8%) had unfavorable outcome at long-term follow-up with a median observation time of 12 months (interquartile range, 3-19). A total of 67 patients (37.9%) died. National Institutes of Health Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), time from stroke onset to recanalization, and recanalization condition were identified as independent predictors for long-term outcome. Over 40% of BAO patients who were treated with modern EVT achieved favorable outcome at long-term follow-up. NIHSS, pc-ASPECTS, time from stroke onset to recanalization, and recanalization condition were identified as independent prognostic factors of long-term outcome.
Collapse
Affiliation(s)
- Longfei Wu
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Da Zhang
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jian Chen
- Department of Neurosurgery, Capital Medical University, Beijing, China
| | - Chenghe Sun
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Kangxiang Ji
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Weili Li
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Emergency, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Di Wu
- Department of Neurology and China-America Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Ritvonen J, Sairanen T, Silvennoinen H, Virtanen P, Salonen O, Lindsberg PJ, Strbian D. Comatose With Basilar Artery Occlusion: Still Odds of Favorable Outcome With Recanalization Therapy. Front Neurol 2021; 12:665317. [PMID: 34017306 PMCID: PMC8130899 DOI: 10.3389/fneur.2021.665317] [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: 02/07/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Around 30–60% of patients with basilar artery occlusion (BAO) present with coma, which is often considered as a hallmark of poor prognosis. Aim: To examine factors that will help predict outcomes in patients with BAO comatose on admission. Methods: A total of 312 patients with angiography-proven BAO were analyzed. Comas were assessed as Glasgow Coma Scale (GCS) of ≤8 or impaired level of consciousness ascertained in the medical records. Outcomes were evaluated with the modified Rankin Scale (mRS) over a phone call at 3 months. In our study, 53 patients were excluded due to inadequate data on the level of consciousness. Results: In total, 103/259 (39.8%) of BAO patients were comatose on admission. Factors associated with acute coma were higher age, coronary artery disease, convulsions, extent of early ischemia by posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) < 8, absence of patent posterior collateral vasculature, and occlusion over multiple segments of BA. A total of 21/103 (20.4%) of comatose patients had a favorable outcome (mRS 0–3), and 12/103 (11.7%) had a good outcome (mRS 0–2). Factors associated with a favorable outcome in comatose BAO patients were younger age (p = 0.010), less extensive baseline ischemia (p = 0.027), recanalization (p = 0.013), and avoiding symptomatic intracranial hemorrhage (sICH) (p = 0.038). Factors associated with the poorest outcome or death (mRS 5–6) were older age (p = 0.001), diabetes (p = 0.022), atrial fibrillation (p = 0.016), lower median GCS [4 (IQR 3.6) vs. 6 (5–8); p = 0.006], pc-ASPECTS < 8 (p = 0.003), unsuccessful recanalization (p = 0.006), and sICH (p = 0.010). Futile recanalization (mRS 4–6) was significantly more common in comatose patients (49.4 vs. 18.5%, p < 0.001). Conclusions: One in five BAO patients with acute coma had a favorable outcome. Older patients with cardiovascular comorbidities and already existing ischemic lesions before reperfusion therapies tended to have a poor prognosis, especially if no recanalization is achieved and sICH occurred.
Collapse
Affiliation(s)
- Juhani Ritvonen
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Tiina Sairanen
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland.,Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Heli Silvennoinen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Pekka Virtanen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Oili Salonen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Perttu J Lindsberg
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland.,Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland.,Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
6
|
Ritvonen J, Sairanen T, Silvennoinen H, Virtanen P, Salonen O, Lindsberg PJ, Strbian D. Outcomes and long-term mortality after basilar artery occlusion-A cohort with up to 20 years' follow-up. Eur J Neurol 2020; 28:816-822. [PMID: 33141492 DOI: 10.1111/ene.14628] [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: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The data on long-term outcome after basilar artery occlusion (BAO) are scarce. Little is known about BAO survivors´ outcome over decades. AIM We set out to investigate long-term survival and causes of death in BAO patients with up to two decades of follow-up. We also evaluated differences in outcome trends. METHODS Two hundred and seven BAO patients treated with intravenous thrombolysis (IVT) at the Department of Neurology, Helsinki University Hospital, between 1995 and 2016, were analyzed. Short-term outcome was assessed by modified Rankin Scale (mRS) at 3 months. Long-term cumulative survival rate was analyzed using Kaplan-Meier analysis. Factors associated with mortality were analyzed with Cox regression. RESULTS Moderate outcome (mRS 0-3) was achieved in 41.1% and good outcome (mRS 0-2) in 30.4% of patients at 3 months. Three-month mortality was 39.6%, of which 89% died within the first month. The median follow-up time in 3-month survivors was 8.9 years (maximum 21.8 years). Total mortality during follow-up was 52.2%. Cumulative mortality rate was 25.7%. Older age, coronary artery disease and more extensive ischemic changes on admission brain imaging were independently associated with long-term mortality. After the acute phase, the rate of other vascular causes of death increased in relation to stroke. CONCLUSIONS The described evolution of a large, single-center BAO cohort shows a trend towards a higher rate of good and/or moderate outcome during later years in IVT-treated patients. Survivors showed relative longevity, and the rate of cardiac and other vascular causes of death increased in relation to stroke sequelae over the long term.
Collapse
Affiliation(s)
- Juhani Ritvonen
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Tiina Sairanen
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland.,Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Heli Silvennoinen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Pekka Virtanen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Oili Salonen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Perttu J Lindsberg
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland.,Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland.,Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
7
|
Blood pressure characteristics in patients with acute basilar artery occlusion undergoing endovascular thrombectomy. Sci Rep 2019; 9:13224. [PMID: 31519971 PMCID: PMC6744431 DOI: 10.1038/s41598-019-49769-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023] Open
Abstract
Acute basilar artery occlusion (BAO) is a rare but potentially life-threatening neurological condition. While endovascular therapy (EVT) has been shown to improve outcome, there is limited knowledge about prognostic factors beyond early recanalization. We studied whether blood pressure (BP) exceeds or falls below suggested thresholds during intervention and whether these changes are associated with complications and outcome. BP measurements mostly with one-minute intervals were available in 39 patients. An individual systolic blood pressure (SBP) reference value was defined as the median of the first five intra-procedural measurements. Half of the patients (51.3%) received drugs for BP augmentation and two a BP lowering drug (5.1%). Thrombolysis in cerebral infarction grade 2b and 3 (TICI) was achieved in 29 (74.4%) and 23 patients (58.9%) had good outcome at three months. We observed a continuous intra-procedural increase of median SBP (+11%) and mean arterial pressure (MAP, +10%, both p < 0.001), and a unique temporal pattern of intermittent peaks and troughs. Successful recanalization was more common in patients whose intra-procedural duration with SBP under 140 mmHg was shorter (p = 0.009). Patients with isolated tip of basilar artery (TBA) occlusion had significantly more BP excursion of 20% below the reference SBP and required more frequent use of sympathomimetic drugs compared to vertebrobasilar occlusion (p = 0.008 and p = 0.041, respectively). Brain hemorrhage was more prevalent in patients who experienced SBP excursions at least 20% above the individual reference value (p = 0.038) and a longer duration of time spent with SBP above 180 mmHg (p = 0.029). Patients with higher pre-procedural mean SBP had a greater chance of a good outcome (p = 0.03). This study using high resolution BP monitoring suggests a relationship between intra-procedural BP characteristics and recanalization, hemorrhagic complications and outcome in patients receiving EVT for acute posterior circulation cerebrovascular syndromes. Differences with regard to BP regulation during recanalization therapy for vertebrobasilar and TBA occlusion deserves further attention.
Collapse
|
8
|
Boeckh-Behrens T, Pree D, Lummel N, Friedrich B, Maegerlein C, Kreiser K, Kirschke J, Berndt M, Lehm M, Wunderlich S, Mosimann PJ, Fischer U, Zimmer C, Kaesmacher J. Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions. Stroke 2019; 50:389-395. [DOI: 10.1161/strokeaha.118.022466] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy.
Methods—
Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients’ characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3.
Results—
One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10–22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97–17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42–179.00).
Conclusions—
Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries.
Collapse
Affiliation(s)
- Tobias Boeckh-Behrens
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - David Pree
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Nina Lummel
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Benjamin Friedrich
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Christian Maegerlein
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Kornelia Kreiser
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Jan Kirschke
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Maria Berndt
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Manuel Lehm
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | | | - Pascal J. Mosimann
- Department of Neurology (P.J.M., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
- Institute of Diagnostic and Interventional Neuroradiology (P.J.M., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (U.F., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Claus Zimmer
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
| | - Johannes Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology (T.B.-B., D.P., N.L., B.F., C.M., K.K., J.K., M.B., M.L., C.Z., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
- Department of Neurology (P.J.M., J.K.), Klinikum Rechts der Isar, Technical University Munich, Germany
- Institute of Diagnostic and Interventional Neuroradiology (P.J.M., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
- Department of Neurology (U.F., J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| |
Collapse
|
9
|
Ritvonen J, Strbian D, Silvennoinen H, Virtanen P, Salonen O, Lindsberg PJ, Sairanen T. Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion. Eur J Neurol 2018; 26:128-135. [DOI: 10.1111/ene.13781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/02/2018] [Indexed: 12/23/2022]
Affiliation(s)
- J. Ritvonen
- Molecular Neurology Research Program Unit Biomedicum Helsinki Department of Clinical Neurosciences University of Helsinki Helsinki
| | - D. Strbian
- Molecular Neurology Research Program Unit Biomedicum Helsinki Department of Clinical Neurosciences University of Helsinki Helsinki
- Department of Neurology Helsinki University Hospital Helsinki
| | - H. Silvennoinen
- Helsinki Medical Imaging Center Helsinki University Hospital University of Helsinki Helsinki Finland
| | - P. Virtanen
- Helsinki Medical Imaging Center Helsinki University Hospital University of Helsinki Helsinki Finland
| | - O. Salonen
- Helsinki Medical Imaging Center Helsinki University Hospital University of Helsinki Helsinki Finland
| | - P. J. Lindsberg
- Molecular Neurology Research Program Unit Biomedicum Helsinki Department of Clinical Neurosciences University of Helsinki Helsinki
- Department of Neurology Helsinki University Hospital Helsinki
| | - T. Sairanen
- Department of Neurology Helsinki University Hospital Helsinki
| |
Collapse
|
10
|
Wyszomirski A, Szczyrba S, Tomaka D, Karaszewski B. Treatment of acute basilar artery occlusion: Systematic review and meta-analysis. Neurol Neurochir Pol 2017; 51:486-496. [DOI: 10.1016/j.pjnns.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
|
11
|
Behzadi GN, Fjetland L, Advani R, Kurz MW, Kurz KD. Endovascular stroke treatment in a small-volume stroke center. Brain Behav 2017; 7:e00642. [PMID: 28413700 PMCID: PMC5390832 DOI: 10.1002/brb3.642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/29/2016] [Accepted: 12/18/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers. PATIENTS AND METHODS A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH). RESULTS Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT. DISCUSSION The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.
Collapse
Affiliation(s)
- Gry N. Behzadi
- Radiological Research GroupDepartment of RadiologyStavanger University HospitalStavangerNorway
| | - Lars Fjetland
- Radiological Research GroupDepartment of RadiologyStavanger University HospitalStavangerNorway
| | - Rajiv Advani
- Neuroscience Research GroupDepartment of NeurologyStavanger University HospitalStavangerNorway
| | - Martin W. Kurz
- Neuroscience Research GroupDepartment of NeurologyStavanger University HospitalStavangerNorway
| | - Kathinka D. Kurz
- Radiological Research GroupDepartment of RadiologyStavanger University HospitalStavangerNorway
- Stavanger UniversityStavangerNorway
| |
Collapse
|
12
|
Da Ros V, Meschini A, Gandini R, Del Giudice C, Garaci F, Stanzione P, Rizzato B, Diomedi M, Simonetti G, Floris R, Sallustio F. Proposal for a Vascular Computed Tomography-Based Grading System in Posterior Circulation Stroke: A Single-Center Experience. J Stroke Cerebrovasc Dis 2016; 25:368-77. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/17/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022] Open
|
13
|
Cognitive and Functional Impairment in Stroke Survivors with Basilar Artery Occlusive Disease. Behav Neurol 2015; 2015:971514. [PMID: 26146461 PMCID: PMC4469759 DOI: 10.1155/2015/971514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Despite growing literature on posterior vascular disease, specific information about the cognitive and functional profiles of patients with basilar artery occlusion disease (BAOD) is scarce. The aims of this study were (1) to compare the cognitive statuses of BAOD survivors versus healthy controls and (2) to correlate the functional capacity outcomes with the cognitive profiles of BAOD patients. Methods. Comprehensive cognitive and functional assessments were carried out in 28 patients with BAOD and 27 age- and education level-matched healthy controls. Results. Compared to matched controls, patients presented impairments in selective, sustained, and set-shifting attention, processing speed, visuospatial skills, mental flexibility, and monitoring rules. There were significant deficits in verbal episodic memory (immediate and delayed recall) and visuospatial episodic memory (immediate and delayed recall and recognition). Functional capacity outcomes were significantly related to the cognitive test results. Seventy-five percent of patients had a Modified Rankin Scale score of 0 or 1. Conclusions. Our results indicate good functional outcomes in a selected group of BAOD survivors, despite the presence of subnormal performance on some cognitive tests, including tests of attention, executive function, and long-term memory.
Collapse
|
14
|
Beyer SE, Hunink MG, Schöberl F, von Baumgarten L, Petersen SE, Dichgans M, Janssen H, Ertl-Wagner B, Reiser MF, Sommer WH. Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis. Stroke 2015; 46:1840-9. [PMID: 26022634 PMCID: PMC4476845 DOI: 10.1161/strokeaha.115.008841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/02/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. METHODS A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits, with a willingness-to-pay threshold of $80,000 per QALY. The strategy with the highest net monetary benefit was considered the most cost-effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values. RESULTS In the reference case analysis, CTA dominated all other imaging strategies. CTA yielded 0.02 QALYs more than magnetic resonance imaging and 0.04 QALYs more than duplex ultrasound followed by CTA. At a willingness-to-pay threshold of $80,000 per QALY, CTA yielded the highest net monetary benefits. The probability that CTA is cost-effective was 96% at a willingness-to-pay threshold of $80,000/QALY. Sensitivity analyses showed that duplex ultrasound was cost-effective only for a prior probability of ≤0.02 and that these results were only minimally influenced by duplex ultrasound sensitivity and specificity. Nonenhanced CT and magnetic resonance imaging never became the most cost-effective strategy. CONCLUSIONS Our results suggest that CTA in patients with possible basilar artery occlusion is cost-effective.
Collapse
Affiliation(s)
- Sebastian E Beyer
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Myriam G Hunink
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Florian Schöberl
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Louisa von Baumgarten
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Steffen E Petersen
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Martin Dichgans
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Hendrik Janssen
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Birgit Ertl-Wagner
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Maximilian F Reiser
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.)
| | - Wieland H Sommer
- From the Institute of Clinical Radiology (S.E.B., B.E.-W., M.F.R., W.H.S.), Department of Neurology (F.S., L.B.), Institute for Stroke and Dementia Research (M.D.), and Department of Neuroradiology (H.J.), Ludwig-Maximilian University of Munich Hospitals, Munich, Germany; Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research, Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, London, United Kingdom (S.E.P.); Department of Radiology (M.G.H.) and Department of Epidemiology (M.G.H.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, MA (M.G.H.).
| |
Collapse
|
15
|
Sairanen T, Strbian D, Ruuskanen R, Silvennoinen H, Salonen O, Lindsberg PJ. Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion. Eur J Neurol 2014; 22:493-9. [PMID: 25482105 DOI: 10.1111/ene.12597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to determine factors associated with symptomatic intracranial haemorrhage (sICH) in basilar artery occlusion patients treated with intravenous thrombolysis (IVT) and adjuvant anticoagulant therapy. METHODS A registry of 176 consecutive patients with angiography-proven basilar artery occlusion who received IVT with alteplase and heparin between 1995 to 2013 was assessed. Post-treatment sICH was evaluated with the European Cooperative Acute Stroke Study II criteria. Unfavourable outcome was defined as a modified Rankin Scale score of 3-6 at 3 months. RESULTS Twenty-four patients developed sICH (13.6%, sICH+), all of whom had unfavourable outcome and only two (8.3%) sICH+ patients survived. On admission, sICH+ patients more frequently had extensive ischaemic changes defined as posterior circulation Acute Stroke Prognosis Early CT Score (PC-ASPECTS) < 8 (50% vs. 27% in sICH-, P = 0.031) and lower platelet counts (183 vs. 218 E9/l; P = 0.011). They also had higher systolic blood pressure (SBP) (median 160 vs. 147 mmHg, P = 0.034) immediately after IVT. In multivariable regression analysis, lower platelet values [odds ratio (OR) 0.99, 95% confidence interval (CI) 0.97-0.996; P = 0.006], PC-ASPECTS < 8 on admission (OR 3.6, 95% CI 1.3-10.3; P = 0.017) and higher SBP after treatment (OR 1.03, 95% CI 1.01-1.05; P = 0.017) were independently associated with sICH. Ninety per cent of the sICHs occurred within 48 h from IVT/anticoagulation treatment. No differences in activated partial thrompoplastin times prior to or after the treatment were observed between sICH+ and sICH- patients. CONCLUSIONS The risk of sICH was largely determined by extension of ischaemic changes on admission computed tomography. Clinically relevantly, also higher post-thrombolytic SBP as described earlier and lower perithrombolytic platelet counts do increase the risk, a finding requiring confirmation in other patient series.
Collapse
Affiliation(s)
- T Sairanen
- Department of Neurology, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | |
Collapse
|
16
|
Quality of life after intra-arterial therapy for acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:1890-6. [PMID: 24813258 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/04/2014] [Accepted: 02/14/2014] [Indexed: 11/20/2022] Open
Abstract
Few data exist about health-related quality of life outcomes after intra-arterial therapy (IAT) for acute ischemic stroke (AIS). We assessed stroke-specific quality of life (SS-QOL) in survivors of stroke after IAT. Consecutive patients undergoing IAT for AIS from 2005 to 2010 were retrospectively identified via an institutional database. SS-QOL (using the SS-QOL score) and disability status (modified Rankin Scale [mRS]) were prospectively assessed via mailed questionnaire. We analyzed quality of life (QOL) scores by domain and summary score, with a summary score of 4 or more defined as a good outcome. Analysis of variance (ANOVA) was used to model the effect of final recanalization status, stroke severity, and mRS on total QOL score. ANOVA and Pearson correlations were used to test the association between stroke severity/mRS and QOL/time since stroke, respectively. Of 99 patients with AIS, 61 responded, yielding 11 interim deaths, 7 incomplete surveys, and 43 complete surveys for analysis. Among responding survivors, overall QOL score was 3.9 (standard deviation 0.7); 77% of these reported good QOL. Scores were higher in recanalized patients in 11 of 12 domains but was significant only for mood. Although mRS was associated with stroke severity, QOL was independent of both. Seventy-seven percent of survivors of AIS who received IAT reported good QOL. Furthermore, these data suggest that SS-QOL is an independent outcome from stroke severity and disability status.
Collapse
|
17
|
Abstract
Basilar artery occlusion has poor outcome in adults; little is known regarding outcomes in children. Whether intra-arterial treatments improve adult outcomes is controversial. Safety and efficacy of intra-arterial treatments in children are unknown. We report 5 cases of basilar artery occlusion and review published cases. We estimated National Institute of Health Stroke Scale (NIHSS) and modified Rankin Score (mRS) of published cases, compared scores between non-intra-arterial treatments and intra-arterial treatments groups, and examined the correlation between NIHSS and mRS. Of our cases, 4 had good outcomes and 1 died. Of 63 published cases, 45 had no intra-arterial treatments and 18 had intra-arterial treatments. In the non-intra-arterial treatments group 24 had good outcomes. In the intra-arterial treatments group 13 had good outcomes. There was strong correlation between the NIHSS and the mRS. Children with basilar artery occlusion have better outcomes than adults. Certain children with basilar artery occlusion may be treated conservatively. A registry for childhood basilar artery occlusion is urgently needed.
Collapse
Affiliation(s)
| | - Warren D. Lo
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| |
Collapse
|
18
|
Block HS, Biller J. Commonly asked questions: thrombolytic therapy in the management of acute stroke. Expert Rev Neurother 2014; 13:157-65. [DOI: 10.1586/ern.12.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
19
|
Switzer JA, Forseen SE, Bruno A, Hess DC. Serendipitous recanalization of basilar artery occlusion. J Stroke Cerebrovasc Dis 2013; 22:e671-3. [PMID: 23834852 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/17/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe a case of recanalization of a basilar artery occlusion with intravenous (IV) tenecteplase. CASE A 74-year-old man with a history of cardiomyopathy presented to an outside hospital with acute vertigo, dysarthria, gaze deviation, and ataxia. Computerized tomography arteriography demonstrated occlusion of the proximal basilar artery. IV tissue plasminogen activator was ordered; however, the patient received a cardiac dose of IV tenecteplase. The patient was transferred to our facility, whereby symptoms resolved, and repeat computerized tomography arteriography displayed recanalization of the basilar artery. CONCLUSIONS Tenecteplase has enhanced biochemical and pharmacokinetic properties that may be ideal for treatment of basilar artery occlusion and should be further investigated in a randomized clinical trial.
Collapse
|
20
|
Affiliation(s)
- Manoëlle Kossorotoff
- Pediatric Neurology Department, French Reference Center for Childhood Stroke, University Hospital Necker-Enfants Malades, Paris, France
| |
Collapse
|