J Cerebrovasc Endovasc Neurosurg.  2018 Sep;20(3):168-175. 10.7461/jcen.2018.20.3.168.

Implications of Mechanical Endovascular Thrombectomy for Acute Basilar and Posterior Cerebral Artery Occlusion

• Lee HN
• Kim BT
• Im SB
• Hwang SC
• Jeong JH
• Chung MY
• Park JH
• Shin DS

• KMID: 2422768
• DOI: http://doi.org/10.7461/jcen.2018.20.3.168

Abstract

OBJECTIVE
Protocols for posterior circulation ischemic stroke have not been established by randomized clinical trials. Mechanical endovascular thrombectomy (MET) devices are evolving, and many of these devices already developed or in development are suitable for posterior circulation MET.
MATERIALS AND METHODS
We investigated the medical records of patients who underwent MET for posterior circulation ischemic stroke from January 2012 to August 2016. Fifteen patients were included. MET was performed in patients with or without injected intravenous tissue plasminogen activator. MET was considered in patients with a National Institute of Health Stroke Scale score of 4 or more, older than 18 years, with definite occlusion of the basilar artery or posterior cerebral artery (PCA), and who arrived at the hospital within 24 hours from onset.
RESULTS
The direct catheter aspiration technique was used in five cases, and the stent retrieval technique was used in seven cases. The stent retrieval technique with the direct aspiration technique was used in three cases. Recanalization failed in two cases. Basilar occlusion without PCA involvement is the only effective factor of successful recanalization (p = 0.03). Successful recanalization (p = 0.005) and the presence of a posterior communicating artery (p = 0.005) affected the good outcome at discharge.
CONCLUSION
An early diagnosis and active MET may improve the patient outcome. MET may help recanalization and good flow restoration and the potential for a good outcome.

Keyword

Ischemic stroke; Mechanical thrombectomy; Basilar artery occlusion; Endovascular treatment

MeSH Terms

Arteries
Basilar Artery
Catheters
Early Diagnosis
Humans
Medical Records
Passive Cutaneous Anaphylaxis
Posterior Cerebral Artery*
Stents
Stroke
Thrombectomy*
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

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  Fig. 1 Patient who occluded at the basilar top with PCA. (A) Top of basilar artery was occluded on initial angiography. (B) Top of basilar artery was recanalization after direction aspiration. However, right PCA was occluded. (C) Right PCA was partial recanalization after retrieval stent apply. (D) Right PCA was not recanalization on final angiography. PCA = posterior cerebral artery.

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  Fig. 2 Patient who occluded at basilar trunk. (A) Trunk of basilar artery was not shown on initial angiography. (B) Thrombus was captured in retrieval stent. (C) Basilar artery was recanalization completely after thrombectomy.

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  Fig. 3 Recanalization failed because the thrombectomy devices could not reach the occlusion vessel. (A) Although guiding wire reached right vertebral artery, diagnostic catheter wasn't able to reach the right vertebral artery because of vascular tortuosity. (B) Left vertebral artery wasn't shown on road map image. (C) angiographic image was taken by right subclavian artery angiography with inflated blood pressure cuff on right arm.

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