Extracranial Vertebral Artery Research Articles

Effect of haemodynamics on the risk of ischaemic stroke in patients with severe vertebral artery stenosis

ObjectivesEndovascular treatment strategies to optimise individualised care for patients with vertebral artery (VA) stenosis need to be revisited. This study aimed to investigate the relationship between net VA flow volume...

Comparison of Doppler Ultrasound and Digital Subtraction Angiography in extracranial stenosis

ObjectiveEvaluating the degree of extracranial stenosis is important in predicting the risk of cerebrovascular events and to assess if the patient can benefit from any intervention. Non-invasive methods, like Doppler Ultrasonography (DUS) are preferred to invasive methods such as Digital Subtraction Angiography (DSA). MethodsIn this retrospective study, the level of agreement between DUS and DSA regarding the degree of stenosis of Internal Carotid Arteries (ICAs) and Vertebral Arteries (VAs) was assessed. The degree of ICA stenosis was classified into 5 groups. DSA was assumed as the gold standard. VA stenosis was classified into two groups of more or less than 50% stenosis. ResultsA total of 428 ICAs were assessed. Based on DSA results, DUS could estimate the degree of arterial stenosis in groups of 0–15% stenosis and 100% stenosis most accurately, and the least accuracy was in groups of 50–69% and 70–99% stenosis. The overall agreement between DUS and DSA in the classified ICA stenosis was moderate (Weighted Kappa = 0.565, P < 0.001). Also, the agreement of DUS and DSA when classifying ICA stenosis into two groups of above and below 50%, was moderate (Kappa = 0.583, P < 0.001). DUS was most sensitive and specific in the group of 100% stenosis (Sensitivity: 0.75 Specificity: 0.99) as well as the group of 1–15% stenosis (Sensitivity: 0.80 Specificity: 0.76). Also, DUS was least sensitive in group of 50–69% stenosis (Sensitivity: 0.11 Specificity: 0.94). Regarding VAS, 108 arteries were assessed and the agreement between DUS and DSA was fair (Kappa = 0.248, CI95 = −0.013 - 0.509, P < 0.01). ConclusionsDUS can be used as the first-line screening tool for detecting extra cranial arteries stenosis. The practicality of the DUS as a screening tool for extracranial VAs stenosis appears to be limited.

Safety and Efficacy of Rapamycin-Eluting Vertebral Stents in Patients With Symptomatic Extracranial Vertebral Artery Stenosis

Background and Purpose: Drug-eluting stents generally have superior performance to bare metal stents in the treatment of vertebral artery stenosis (VAS). This prospective, multicenter, and single-arm clinical trial was initiated to assess in-stent restenosis (ISR) and midterm outcome after rapamycin-eluting stent placement in patients with symptomatic extracranial VAS.Methods: The subjects underwent angiographic follow-up at 6 months and final clinical follow-up at 12 months. The primary efficacy endpoint was ISR at 6 months. Secondary endpoints included technical success, target lesion-related transient ischemic attack (TIA), stroke, or death, and all-cause TIA, stroke, or death during the 12-month follow-up period.Results: A total of 104 stents were implanted in the 101 patients and 83 patients (82.2%) completed angiographic follow-up at 6 months. The technical success rate was 86.1% (87/101); mean in-stent stenosis rate was 25.1 ± 17.1% and ISR rate was 5.9% (95% CI: 0.8–10.9%). All the patients with ISR were completely asymptomatic and no stent fractures were observed during angiographic follow-up. At the 12-month clinical follow-up, target lesion-related TIA, stroke, or death had occurred in two (2.0%) patients and all-cause TIA, stroke, or death had occurred in six (6.1%) patients.Conclusion: The placement of rapamycin-eluting stents in patients with symptomatic extracranial VAS yields favorable ISR results and showed a trend of favorable safety outcomes including low rates of perioperative complications and late stroke. However, further study is needed to establish the long-term clinical benefits of this stent in the treatment of VA disease.

Posterior circulation stroke due to vertebral artery disease in the Chinese population.

Little is known about the distribution of the arteries responsible for noncardiogenic posterior circulation stroke due to vertebral artery disease in the Chinese population. Furthermore, few studies have compared the risk factors, imaging manifestations, and outcomes across different types of vertebral artery disease. Therefore, our aim was to compare the differences in the risk factors, imaging manifestations, and outcome across various types of vertebral artery disease. We prospectively enrolled 228 patients from 22 Chinese centers with noncardiogenic posterior circulation stroke due to vertebral artery disease. Vertebral artery disease was classified by the involved segments of the responsible vertebral artery, and basilar artery (BA) involvement or not. Risk factors, clinical-radiologic patterns, and outcomes were compared across different types of vertebral artery disease. The intracranial vertebral artery (ICVA) was more frequently involved than was the extracranial vertebral artery (ECVA). The ICVA/ICVA + ECVA group more often presented with hypertension and higher systolic blood pressure than did the ECVA group. Compared with the single-segment-of-vertebral-artery group (SSVA), the group with multiple-segments-of-vertebral-artery (MSVA) involvement or SSVA with BA involvement had more serious clinical-radiologic patterns and worse outcomes. Multivariable Cox regression identified MSVA/SSVA + BA involvement as an independent predictor of recurrent ischemic cerebrovascular events. The risk factors for ICVA/ICVA + ECVA were different from those of ECVA, and the MSVA/SSVA + BA group had more serious clinical-radiologic patterns and worse outcomes.

Derivation and validation of a quantitative screening model for blunt cerebrovascular injury.

The objective of this study was to derive and validate a new screening model using a nomogram that allows clinicians to quantify the risk of blunt cerebrovascular injury (BCVI). In this study, the authors examined 258,935 patients from a prospectively collected nationwide Japanese database (January 2009-December 2018) who experienced blunt injury. Patients were randomly divided into training (n = 129,468) and validation (n = 129,467) cohorts. First, the authors investigated the prevalence of BCVI, which was defined as blunt injury to any intracranial vessel, the extracranial vertebral artery, the extracranial carotid (common, internal) artery, or the internal jugular vein. Then, a new arterial BCVI screening model using a nomogram was derived, based on multivariate logistic regression analysis through quantifying the association of potential predictive factors with BCVI in the training cohort. The model's discriminatory ability was validated using the area under the receiver operating characteristic curve (AUC) in the validation cohort. Multivariate analysis in the training cohort showed that 13 factors were significantly associated with arterial BCVI and were included in our model. These factors were 1) male sex; 2) high-energy impact; 3) hypotension on hospital arrival; 4) Glasgow Coma Scale score < 9; 5) injury to the face; 6) injury to the neck; 7) injury to the spine; 8) skull base fracture; 9) cervical spine fracture or subluxation; and those with negative associations, i.e., 10) injury to the lower-extremity region; 11) supratentorial subdural hemorrhage; 12) lumbar spine fracture or subluxation; and 13) soft tissue injury of the face. In the validation cohort, the model had an AUC of 0.83 (95% CI 0.81-0.86). When the definition of BCVI was narrowed to include only carotid (common, internal) and vertebral artery injuries, the AUC of the model in predicting these injuries was 0.89 (95% CI 0.87-0.91). A new screening model that incorporates an easy-to-use nomogram to quantify the risk of BCVI and assist clinicians in identifying patients who warrant additional evaluation was established.

Intraplaque Enhancement Is Associated With Artery-to-Artery Embolism in Symptomatic Vertebrobasilar Atherosclerotic Diseases.

Objective: There are limited data regarding the characteristics of intracranial plaques according to stroke mechanism in the posterior circulation. This study aims to compare whether the plaque characteristics and baseline features are different in patients with artery-to-artery (A-to-A) embolism and those with parent artery disease in the intracranial vertebrobasilar atherosclerotic disease.Methods: From September 2014 to January 2017, patients with recent posterior circulation stroke due to intracranial vertebrobasilar atherosclerotic disease were retrospectively analyzed. Patients with the following eligibility criteria were included: (1) age ≥18 years old, (2) ischemic stroke in the vertebrobasilar territory, (3) 70–99% stenosis of the intracranial vertebral artery or basilar artery, and (4) two or more atherosclerotic risk factors. Patients with concomitant ipsilateral or bilateral extracranial vertebral artery >50% stenosis, cardio-embolism, or non-atherosclerotic stenosis were excluded. The plaque characteristics, including intraplaque compositions (intraplaque hemorrhage and intraplaque calcification), intraplaque enhancement, and remodeling index, were evaluated by using 3T high-resolution magnetic resonance imaging (HRMRI). The baseline features including vascular risk factors and the involved artery were collected. Patients were divided into A-to-A embolism and parent artery disease groups based on the diffusion-weighted images, T2-weighted images, or computed tomography. The plaque characteristics and baseline features were compared between the two groups.Results: Among consecutive 298 patients, 51 patients were included. Twenty-nine patients had A-to-A embolism and 22 patients had parent artery disease. Compared with parent artery disease, the occurrence rates of intraplaque enhancement and intracranial vertebral involvement were higher in the A-to-A embolism group (79.3 vs. 36.4%; p = 0.002 and 62.1 vs. 18.2%; p = 0.002, respectively). Multivariable logistic regression analysis showed that intraplaque enhancement and intracranial vertebral artery plaques were also associated with A-to-A embolism (adjusted OR, 7.31; 95% CI 1.58–33.77; p = 0.011 and adjusted OR, 9.42; 95% CI 1.91–46.50; p = 0.006, respectively).Conclusion: Intraplaque enhancement and intracranial vertebral artery plaques seem to be more closely associated with A-to-A embolism than parent artery disease in patients with symptomatic intracranial vertebrobasilar disease.Clinical Trial Registration:http://www.clinicaltrials.gov, identifier: NCT02705599.

Asymptomatic Complete Occlusion of Extracranial Internal Carotid Artery: A Case Report

This article reports on head-and-neck computed tomography angiography imaging findings and data of ultrasound examination of the extracranial carotid and vertebral arteries of 69-year-old patient with unilateral asymptomatic complete occlusion of extracranial internal carotid artery (ICA) in combination with unusually elongated styloid processes of temporal bone. The aim of the study was to specify the collateral pathways blood supply to the brain and to assess the possible clinical significance of an abnormally elongated styloid pro cess. Adequate cerebral blood flow was provided by anastomoses between the arteries at the base of the brain. This can explain the asymptomatic unilateral complete occlusion of the extracranial ICA. Occlusion of the artery was not associated with the presence of a 5.5 cm styloid process. Computed tomography angiography is a highly informative method for visualizing the individual morphological variants to clarify their clinical significance.

Prevalence and characteristics of atherosclerotic plaque: Left compared with right arteries and anterior compared with posterior circulation stroke

PurposeTo evaluate atherosclerotic plaque prevalence and characteristics between left and right cervicocephalic arteries and between anterior and posterior circulation stroke (ACS and PCS). MethodsThis retrospective study included 284 patients with acute ischemic stroke (199 ACS and 85 PCS) involving large-artery atherosclerosis or small-artery occlusion. We assessed atherosclerotic plaque prevalence and characteristics (plaque type, plaque surface morphology, plaque distribution, location of calcified nodules and plaque thickness) in each segment and their comparisons between left and right arteries and between ACS and PCS. ResultsThe left subclavian artery (L-SA), common carotid artery (L-CCA) and intracranial vertebral artery (L-IVA) had significantly higher prevalence of atherosclerotic plaque than the right (R) corresponding arteries (70.1% versus 59.5%, P = 0.008), (48.1% versus 28.9%, P < 0.001), (23.9% versus 16%, P = 0.018), respectively. L-SA had a higher prevalence of mixed plaque (non-calcified > calcified) (19.6% versus 16.4%) and noncalcified plaque (51.9% versus 31.7%), and a lower prevalence of calcified plaque (8.9% versus 23.3%) and mixed plaque (calcified > non-calcified) (19.6% versus 28.6%) than R-SA, P < 0.001. The distribution of plaque type in the SA and extracranial vertebral artery (EVA) were significantly different between ACS and PCS. The soft plaque thickness of SA in PCS was significantly greater than that in ACS (3.85 ± 1.27 versus 3.51 ± 1.04, P = 0.032). ConclusionsAtherosclerotic plaque prevalence and characteristics vary in different segments, sides and between ACS and PCS. These differences should be noted during plaque diagnosis.

Usage and Efficiency of Drug Eluting Stents in Vertebral Ostial Stenosis

Objectives: Extracranial vertebral artery atherosclerosis is an insidious and hazardous disease. With technological development and accumulating experience, antiproliferative drug eluting stents became a viable option for reducing the instent restenosis of the origin of the vertebral artery. Here, we evaluated the technical success rates, efficiency, clinical and angiographic results of the usage of drug eluting stents in vertebral ostial stenosis. Patients and Methods: 28 stents were implanted in 24 patients with vertebral artery origin stenosis. Digital substraction angiographic or CT angiographic follow-up was made at 6, 12 and 24 months. Results: Paclitaxel eluting stents were placed with high technical success for the treatment of vertebral artery origin stenosis. There was no procedure related mortality. However one patient scummed to death due to aspiration pneumonia for a basiller artery stroke with successful stenting and thrombolysis procedure. There was only one limited subclavian artery dissection in a patient (%4.1) during the procedure which was managed conservatively. One stent (%3.7) had instent restenosis on early period (6th month) and one patient (%4.1) had recurrent neurological symptoms on follow-up (9th month). In a median follow-up of 13 months (6-25 months) none of the patients had late stent thrombosis. Conclusion: Vertebral artery ostial stenosis can be treated effectively and safely with high technical success and low instent restenosis rates with paclitaxel drug eluting stents. With low restenosis rates the antiproliferative drug eluting stents are an option for reducing the vertebral artery instent restenosis.

Possibilities of Magnetic Resonance Imaging in the Diagnosis of Changes in the «Vascular Wall» in Giant Cell Arteritis

The aim of the study: to identify features of extracranial carotid and vertebral arteries vessel wall MRI in norm and pathology using layer-by-layer analysis of the arterial wall components. MRI results were compared at the same anatomical level with data of ultrasound examination of vertebral arteries in patients with giant cell arteritis and in health individuals. It was revealed that in normal arteries MRI signal from the vessel wall mainly formed by vascularized adventitia and venous plexuses. Media and intima visualization becomes possible in cases of their pathological transformation. Thus, it was defined which structures of the vessel wall take part in MRI signal forming in health individuals and patient with pathology. Also MRI patterns of different stages of large arteries vasculitis were identified.

3. EXTRACRANIAL CAROTID AND VERTEBRAL ARTERIES PROFILE IN DIZZINES

Background: Dizziness is one of the most common neurologic symptoms found in clinical practice. Carotid and vertebral ultrasound can be performed to detect any factors predisposing dizziness. Objective: This study aimed to describe the profile of extracranial carotid and vertebral arteries using carotid and vertebral ultrasound in dizziness. Methods: This was a retrospective cross-sectional study using the registry of Neurology Outpatient Clinic, RSUPN Dr. Cipto Mangunkusumo, Jakarta from January 2018 until September 2020. Characteristics of subjects with dizziness were evaluated using carotid and vertebral ultrasound. Results: Of 2,699 subjects referred to transcranial doppler/carotid doppler (TCD-CD) clinic, there were 121 (4.53%) with dizziness. Incomplete data of 48 subjects were excluded. There were 42 (57.5%) female and 31 (42.5%) male with the mean age of 53.9 ± 14.5 years. Hypertension was found in 43 (58.9%) subjects. Thickening of intima medial complex was found in 20 (27.4%) subjects. Carotid artery abnormalities were found in 23 (31.5%) subjects. Soft plaque, hard plaque, and mixed plaque were found in 9, 8, and 1 subject, respectively. Tortous arteries were found in 3 subjects. Vertebral artery abnormalities were found in 3 (4.1%) subjects, in which 2 subjects had stenosis in bilateral vertebral arteries and one subject had occlusion in right vertebral artery. Conclusion: Carotid and vertebral ultrasound can be performed in dizziness to evaluate extracranial carotid and vertebral arteries as one of the risk factors of dizziness. Some extracranial carotid and vertebral artery abnormalities including artherosclorosis, plaque, and stenosis may present in dizziness.

Extracranial vertebral artery to middle cerebral artery bypass in therapeutic internal carotid artery occlusion for epipharyngeal carcinoma: A technical case report.

Background: Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture.Methods: A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx.Results: The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy.Conclusion: ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.

Cervical duplex ultrasound for the diagnosis of giant cell arteritis with vertebral artery involvement

ABSTRACTGiant cell arteritis (GCA) is a systemic inflammatory arteriopathy of medium and large‐sized arteries, predominantly affecting branches of the external carotid artery. Ischemic stroke has been reported in 2.8–7% of patients diagnosed with GCA. The majority of ischemic strokes may involve the posterior circulation as a result of vertebral and/or, less frequently, of basilar artery vasculitis. Prompt diagnosis is crucial since high‐dose corticosteroid treatment is highly effective in preventing the occurrence or recurrence of ischemic complications, including posterior circulation ischemic stroke in cases with vertebrobasilar involvement. Cervical duplex sonography (CDS) of the temporal arteries is a powerful diagnostic tool with high sensitivity and specificity for the diagnosis of GCA. In cases with clinical suspicion or a temporal artery ultrasonographic confirmation of GCA, a detailed evaluation of the cervical, axillary, and intracranial arteries with CDS and transcranial‐duplex‐sonography, respectively, should be part of the ultrasound examination protocol. Specifically, signs of extracranial vertebral artery wall inflammation (“halo” sign) and focal luminar stenoses may be accurately depicted by ultrasounds in high‐risk patients or individuals with ischemic stroke attributed to GCA. In this review, we present three cases of GCA and posterior circulation ischemic complications that were initially evaluated with comprehensive neurosonology protocol and were promptly diagnosed with GCA based on the characteristic “halo” sign in the temporal and vertebral arteries. In addition, we discuss the relevant literature concerning the utility of CDS for the early diagnosis of GCA, focusing on the subtype with extracranial arterial involvement, particularly that of the vertebral arteries.

A novel angiographic classification for the endovascular recanalization of symptomatic nonacute extracranial vertebral artery occlusion

BackgroundThere remains major uncertainty regarding the optimal therapy for symptomatic nonacute extracranial vertebral artery occlusion (EVAO). Endovascular recanalization for EVAO is technically challenging, and limited data are available. This research...

Endovascular Treatment of a Primary Extracranial Vertebral Artery Aneurysm Causing Ischemic Stroke

Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; various surgical and endovascular treatment options are available. We report a 44-year-old man with a symptomatic proximal extracranial vertebral artery aneurysm of unclear etiology. The patient presented with brainstem infarction, and the diagnosis of primary extracranial vertebral artery aneurysm was made by computed tomography angiography (CTA). This patient's aneurysm was definitively treated using an endovascular approach with placement of a covered stent in the right proximal vertebral artery. Although aneurysms of this location are traditionally repaired with open aneurysmectomy, we show that endovascular treatment can be a safe and effective alternative approach. In the case reported here, primary extracranial vertebral artery aneurysm presenting with embolic stroke was successfully treated with a covered stent. Complete exclusion of the aneurysm from blood circulation is advisable to achieve full resolution of the embolic source.

FEATURES OF HEMODYNAMICS IN HEAD MAGISTRAL AND CEREBRAL ARTERIES IN THE PATIENTS WITH MIGRAINE

The aim of the study was to Doppler sonography study of the structural and functional state of head magistral arteries (HMA) and cerebral arteries in the patients with various forms of migraine. Materials and methods: We conducted the clinical Doppler examination of 124 young patients (18-45 years old), including 55 men and 69 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2017-2019. The criteria for involvement of patients in the study were: migraine without aura (group 1 – 63 patients), migraine with aura (group 2 – 61 patients) The control group consisted of 45 patients of the corresponding gender and age. The condition of HMA and cerebral arteries was studied using the ultrasound device. Results: The presence of extravasal compressions of vertebral arteries (VA) is typical for the patients with migraine, as well as for some cases of the hypoplasia of the VA in the group of the patients with migraine with aura. In the patients with migraine with aura, there was a decrease in the velocity values in the extracranial VA segments. The velocity values in the external carotid arteries (ECA) were slightly reduced in both groups. The most significant were the changes in the hemodynamics in the middle cerebral arteries (MCA), which were manifested by the pattern of the excessive perfusion in the patients of the migraine without aura and the pattern of the hampered perfusion in the MCA in the patients of the migraine with aura. Conclusions: 1. In the patients with migraine with aura, a decrease in the velocity values in the extracranial segments of the VA was observed, in some cases combined with the hypoplasia of the vertebral artery, the hampered perfusion in middle cerebral arteries. 2. The excessive perfusion in middle cerebral arteries is the most critical hemodynamic pattern in the patients with migraine without aura. 3. The extravasal compression of vertebral arteries, combined with the hyperperfusion in posterior cerebral arteries, is a typical hemodynamic pattern both in the group of the patients with migraine with aura, and in the group of the patients with migraine without aura.

Ultrasound Assessment of Extracranial Carotids and Vertebral Arteries in Acute Cerebral Ischemia.

Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation of extracranial vasculature. CDU has the advantages of a low cost, easily applicable, bed side examination with high temporal and spatial resolution and without exposing the patients to any significant complications. It represents an easily repeatable test that can be performed in the emergency room as a first-line examination of cervical artery pathology. CDU provides well validated estimates of the type of the atherosclerotic plaque, the degree of stenosis, as well as structural and hemodynamic information directly about extracranial vessels (e.g., subclavian steal syndrome) and indirectly about intracranial circulation. CDU may also aid the diagnosis of non-atherosclerotic lesions of vessel walls including dissections, arteritis, carotid-jugular fistulas and fibromuscular dysplasias. The present narrative review outlines all potential applications of CDU in acute stroke management and also highlights its potential therapeutic implications.

Management of Cervico-Cranial Arterial Dissections

Cervico-cranial arterial dissections are a distinct etiology of both ischemic and hemorrhagic neurovascular events. These dissections can involve the extracranial carotid or vertebral arteries, classified collectively as cervical artery dissections, or can be intracranial arterial dissections, and complications and management of each differ. The most recent evidence is reviewed in this publication. Significant heterogeneity regarding treatments of dissections exists among providers and with recent advances in endovascular approaches to neurovascular care, appreciating the latest evidence on the guidance of treatment has never been so challenging. Furthermore, recognizing the complications of cervico-cranial dissections and implementing appropriate therapies can have a significant impact on patient outcomes. Overall, limited randomized controlled data exists regarding the treatment of cervico-cranial dissections. Approach to management of these dissections and potential complications is largely based on observational studies and reported cases. The available evidence and strength vary depending on the case and complication.

Vertebral Artery Stenosis

Vertebral artery stenosis is a common condition associated with a very high risk of stroke. The goal of this review is to summarize the pathophysiology and natural history of vertebral artery stenosis and to evaluate the efficacy of medical and endovascular therapies. Early and aggressive initiation of medical care combined with advancements in antithrombotic and lipid-lowering therapies has substantially reduced the risk of stroke due to vertebral artery stenosis. Endovascular therapy does not appear to be beneficial with extracranial vertebral artery stenosis and appears harmful with intracranial vertebral artery stenosis. Risk of stroke due to symptomatic vertebral artery stenosis can be significantly reduced with implementation of standardized best medical therapy protocols focusing on ultra-early dual antiplatelet therapy, high-intensity statin therapy + novel lipid-lowering agents, and aggressive risk factor control. Endovascular therapy with angioplasty and stenting is not likely to play a significant role in treatment.

Outcome and recanalization rate of tandem basilar artery occlusion treated by mechanical thrombectomy

BackgroundTandem basilar artery occlusions (tBAO) are defined as concomitant basilar artery and extracranial dominant vertebral artery occlusions. The prognosis of such tBAO treated by mechanical thrombectomy (MT) has been scantly reported.The purpose of our study was to compare the safety and effectiveness of MT for patients with tBAO compared to those with non-tandem basilar artery occlusions (ntBAO). Patients and methodsRetrospective analysis of a database of patients who underwent MT at two academic centres. All patients treated for BAO were retrieved. Patients with tBAO, defined as a concomitant BAO and extracranial vertebral artery (VA) occlusion or severe stenosis ≥70% (V1 or proximal V2 segment) were compared with patients with ntBAO. ResultsA total of 15 patients with tBAO and 74 patients with ntBAO were enrolled. Successful reperfusion (modified thrombolysis in cerebral infarction score ≥2b) was obtained in 73.3% versus 90.5% (OR = 0.29, 95%CI: 0.07–1.15), good clinical outcome (3-months modified Rankin scale ≤2) was reached by 26.7% versus 32.4% (OR = 0.76; 95% CI: 0.24–2.63) and mortality at 3-months was 46.7% versus 31% (OR = 1.94; 95%CI: 0.63–6) of patients with tBAO versus ntBAO, respectively. Two patients (13.3%) with tBAO and three (4%) with ntBAO had symptomatic intracranial haemorrhage (OR = 3.64; 95% CI: 0.55–24). ConclusionMechanical thrombectomy for patients with tandem basilar artery occlusion tends to be associated with lower rates of successful reperfusion and good clinical outcome, and higher rate of mortality. Larger multicentre studies are warranted to better precise the proper selection and management of such patients.