Abstract Number ‐ 75: Simultaneous Extracranial‐Intracranial Management of Tandem Lesion (Seimless Technique) in Posterior Circulation Stroke

Abstract

Introduction Simultaneous extracranial‐intracranial management of Tandem lesion in stroke (Seimless technique) is well published and important technique in treating tandem lesions in anterior circulation. However, this technique has been rarely used in the posterior circulation. We present the case of a 70 year‐old male presented with coma and was found to have right vertebral artery origin stenosis with super‐imposed thrombus and tandem occlusion of the basilar artery. We used endovascular Seimless technique successfully with TICI‐3 reperfusion score and good clinical outcome. To our knowledge, this is the first case report for endovascularSeimless technique used in the post circulation. Methods We reviewed our endovascular mechanical thrombectomy data from May 2019 to July 2022 and those with post circulation tandem occlusion were selected. Baseline demographics and clinical presentation were obtained including clinical outcome. Results 70 year‐old male with history of high blood pressure presented with state of coma was found to have right vertebral artery origin stenosis with superimposed pedunculated thrombus and tandem distal third Basilar artery occlusion. Patient underwent simultaneous extracranial‐intracranial management of tandem lesions (Seimless technique) through right trans radial basilar artery thrombectomy with stent retriever and aspiration as well as right vertebral artery origin aspiration and balloon angioplasty over the wire of the stent retriever. Following day, the patient underwent right trans‐radial vertebral artery origin stenosis stenting. Patient’s neurological exam was improved from NIHSS 30 to 0 at the time of discharge. We performed Basilar artery thrombectomy using Rist catheter, Red 62 reperfusion catheter, Rebar microcatheter and Solitaire stent retriever4 mm x 41 mm. After deploying the stent retriever, we advanced sterling balloon 4 mm x 20 mm over the stent retrieverwire and performed optimal balloon angioplasty. Conclusions This particular technique of treating intracranial and extracranial lesion simultaneously for posterior circulation hasn’t been reported in the literature. By presenting this case, we want to conclude that in selective posterior circulation tandem occlusion strokes “Seimless technique” can be used effectively and safely without many complications.