Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke

José E. Cohen*, Ronen R. Leker, J. Moshe Gomori, Roni Eichel, Gustavo Rajz, Samuel Moscovici, Eyal Itshayek

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Patients suffering from acute atherothrombotic occlusion of the proximal vertebral artery (VA) and concomitant basilar artery (BA) occlusion present a grim prognosis. We describe our experience in the endovascular recanalization of tandem vertebrobasilar occlusions using endovascular techniques. The BA was accessed through the normal VA (clean-road) or the occluded, thrombotic VA (dirty-road), and stentriever-based thrombectomy was performed using antegrade or reverse revascularization variants. Seven patients underwent successful stentriever-assisted mechanical thrombectomy of the BA and five sustained concomitant VA revascularization. Stroke onset to endovascular intervention initiation (time-to-treatment) ranged from 4.5–13 hours (mean 8.6). In two of seven patients, the BA occlusion was approached with a ‘clean-road’ approach via the contralateral VA; in five of seven patients, a ‘dirty-road’ approach via the occluded VA was used. Mean time-to-recanalization was 66 minutes (range 55–82). There were no perforations, iatrogenic vessel dissections, or other technical complications. Four patients presented mild-to-moderate disability (modified Rankin Scale [mRS] 0–3) at 3 months, one remained with moderate-to-severe disability (mRS 4), and two patients died on days 9 and 23 after their strokes. Follow-up ranged from 6–45 months (mean 24 months). In selected patients with acute VA-BA occlusion, stentriever-based thrombectomy performed through either the patent or the occluded VA, may be feasible, effective, and safe. Clinical outcomes in these patients seem to equipoise the neurological outcome of patients with successful revascularization for isolated BA occlusion. This unique pair of occlusions confirms the role of VA ostium stenosis as a cause of vertebrobasilar stroke.

Original languageEnglish
Pages (from-to)70-76
Number of pages7
JournalJournal of Clinical Neuroscience
Volume34
DOIs
StatePublished - 1 Dec 2016
Externally publishedYes

Keywords

  • Basilar artery occlusion
  • Stroke
  • Tandem occlusion
  • Thrombectomy
  • Thrombolysis
  • Vertebral artery occlusion

Fingerprint

Dive into the research topics of 'Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke'. Together they form a unique fingerprint.

Cite this