Acute stenting and thromboaspiration in basilar artery occlusions due to embolism from the dominating vertebral artery

Intra-arterial thrombolysis (IAT) is the only treatment that has demonstrated benefit in patients with acute basilar artery occlusions (ABAO). IAT may be difficult to perform when access to the occluded basilar artery (BA) is prevented by pathology of the vertebral arteries (VA). We report on two patients with ABAO due to embolism from the dominating VA. Catheter navigation through the occluded VA and thromboaspiration enabled access to the BA. Thromboaspiration alone or in addition to IAT resulted in a complete recanalization of the BA and a favorable clinical outcome. A stent was deployed at the site of the stenosis in the VA either prior to or immediately after BA recanalization.

[1]  R. Adams,et al.  Occlusion of the basilar artery; a clinical and pathological study. , 1946, Brain : a journal of neurology.

[2]  W. Hacke,et al.  Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. , 1996, Stroke.

[3]  G. Schroth,et al.  Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[4]  Gregory,et al.  Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. , 1988, Stroke.

[5]  P. Desgranges,et al.  Acute occlusion of popliteal and/or tibial arteries: the value of percutaneous treatment. , 2000, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[6]  I. Baumgartner,et al.  Percutaneous catheter thrombus aspiration for acute or subacute arterial occlusion of the legs: how much thrombolysis is needed? , 2000, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[7]  S. Wisniewski,et al.  Factors affecting survival rates for acute vertebrobasilar artery occlusions treated with intra-arterial thrombolytic therapy: a meta-analytical approach. , 1999, Neurosurgery.

[8]  A. Thie,et al.  Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (r-TPA) , 2004, Neuroradiology.

[9]  C. Fisher,et al.  Atherosclerosis of the Carotid and Vertebral Arteries—Extracranial and Intracranial , 1965 .

[10]  M. Diringer,et al.  Relationship between clot location and outcome after basilar artery thrombolysis. , 1997, AJNR. American journal of neuroradiology.

[11]  C. Derouesné,et al.  Arterial occlusions in the vertebro-basilar system. A study of 44 patients with post-mortem data. , 1973, Brain : a journal of neurology.

[12]  C. Groden,et al.  Endovascular Therapy of Acute Vertebrobasilar Occlusion: Early Treatment Onset as the Most Important Factor , 2002, Cerebrovascular Diseases.

[13]  C. Derdeyn,et al.  Collateral circulation and outcome after basilar artery thrombolysis. , 1998, AJNR. American journal of neuroradiology.

[14]  GerhardSchroth,et al.  Local Intra-Arterial Thrombolysis in Acute Ischemic Stroke , 1998 .

[15]  J. Ulatowski,et al.  Intraarterial thrombolysis in vertebrobasilar occlusion. , 1996, AJNR. American journal of neuroradiology.

[16]  G. Ladurner,et al.  Thrombolytic treatment for acute occlusion of the basilar artery. , 1995, Journal of neurology, neurosurgery, and psychiatry.

[17]  C. Mounayer,et al.  Thromboaspiration in the basilar artery: report of two cases. , 2002, AJNR. American journal of neuroradiology.