Vertebral Basilar Artery Research Articles

The impact of increased cardiac output induced by dobutamine on cerebral blood flow based on MRI 3D-pcASL technology

Objective: To investigate the effect of increased cardiac output induced by dobutamine on cerebral blood flow (CBF) in healthy volunteers using magnetic resonance 3D-pseudo-continuous arterial spin labeling technology. Methods: A prospective study was conducted on 48 healthy volunteers recruited by handy sampling from June 2021 to January 2022. Physiological parameters before (at rest state) and after (under stress state) dobutamine-induced increase in cardiac output were analyzed. Quantitative CBF maps were generated by using arterial spin labeling difference imaging and proton density weighted reference image processing, and CBF changes under the rest and stress states were compared. Multivariable logistic regression model was used to analyze factors associated with reduced CBF. Results: A total of 48 subjects were included, with an age [M (Q1, Q3)] of 25.0 (24.0, 28.0) years, including 43 men and 5 women. Compared with the rest state, the CBF in the anterior cerebral artery [(36.2±6.9) vs (34.5±6.5) ml·(100 g)-1·min-1, P=0.006] and the middle cerebral artery perfusion area [(35.8±6.5) vs (34.1±6.4) ml·(100 g)-1·min-1, P=0.006] decreased under the stress state, however there was no statistically significant change in CBF in the posterior cerebral artery and the vertebral-basilar artery perfusion area (all P>0.05). Logistic regression analysis showed that the decrease in CBF in the anterior cerebral artery and middle cerebral artery supply regions during the stress state were correlated with an increase in diastolic blood pressure [OR (95%CI): 0.887 (0.796-0.989) and 0.895 (0.805-0.994), both P<0.05]. Conclusions: Dobutamine-induced increase in cardiac output leads to a decrease in CBF in anterior cerebral circulation but has no effect on posterior circulation. The increase in diastolic blood pressure is associated with decreased CBF under the stress state. Changes in CBF should be considered in the context of increased cardiac output.

MCA Parallel Anatomic Scanning MR Imaging-Guided Recanalization of a Chronic Occluded MCA by Endovascular Treatment.

Basi-parallel anatomic scanning has been widely used for assessing the vascular morphology of vertebral basilar arteries. Previous studies have demonstrated its efficacy in evaluating the morphology of the MCA, which we refer to as MCA parallel anatomic scanning MR imaging (MCPAS). In this study, we present our experience with the application of MCPAS in patients with MCA occlusion. Endovascular treatment was performed on the patients with intact MCA morphology visible in on MCPAS, with no intracranial hemorrhage, occlusion, or other complications observed. No severe stenosis or re-occlusion was observed at the 12-month postoperative follow-up. In conclusion, MCPAS is an effective method for assessing the outer contour of an occlusive MCA. Endovascular treatment can be considered a safe and efficient option for patients who show a favorable MCA through MCPAS assessment.

An analysis of clinical characteristics of rare bilateral medial medullary infarction: An observational study.

This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of bilateral medial medullary infarction (BMMI). A retrospective analysis was conducted on 11 patients with BMMI who met the inclusion criteria at the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2023. The patients' imaging and clinical features were analyzed and summarized. Eleven patients (7 male, 4 female), aged 46 to 62 years, met the inclusion criteria. Common clinical presentations included dysarthria (90.9%), dysphagia (90.9%), quadriplegia (81.8%), and so on. Within 72 hours of onset, 8 cases presented with quadriplegia, 2 cases with hemiplegia, and 1 case without limb paralysis. The main risk factor for BMMI was hypertension, followed by diabetes. "Heart appearance" infarcts occurred in 4 cases (36.4%), while "Y appearance" infarcts occurred in 7 cases (63.6%). Among the patients, 3 had unilateral vertebral artery stenosis or occlusion, 5 had bilateral vertebral artery stenosis or occlusion, 2 had normal vertebral basilar artery, and 1 did not undergo cerebrovascular examination. All patients received standardized treatment for cerebral infarction. The prognosis was poor, with 81.8% of patients having an unfavorable outcome, including 1 death, 9 cases of disability, and only 1 patient achieving self-care ability after recovery. BMMI is more prevalent in males aged 45 to 60 years. The main risk factors are hypertension and diabetes. Atherosclerosis is the primary etiological subtype. The main clinical manifestations are dyskinesia, dizziness, quadriplegia, and dysarthria. The prognosis of BMMI is poor. The specific imaging features of "heart appearance" or "Y appearance" infarcts aid in the diagnosis of BMMI.

The effect of microvascular decompression of the CN IX-X root entry/exit zone and the ventrolateral medulla in neurogenic hypertension involving the vertebral/basilar artery.

Neurogenic hypertension (HTN) is a type of HTN characterized by increased activity of the sympathetic nervous system. Vascular compression is one of the pathogenic mechanisms of neurogenic HTN. Despite Jannetta's solid anatomical and physiological arguments in favor of neurogenic HTN in the 1970's, the treatment for essential HTN by microvascular decompression (MVD) still lacks established selection criteria. Therefore, the subjects selected for our center were limited to patients with primary trigeminal neuralgia (TN) and primary hemifacial spasm (HFS) of the vertebral/basilar artery (VA/BA) responsible vessel type coexisting with neurogenic HTN who underwent MVD of the brainstem to further explore possible indications for MVD in the treatment of neurogenic HTN. A retrospective analysis of 63 patients who were diagnosed with neurogenic HTN had symptoms of HFS and TN cranial nerve disease. Patients were treated at our neurosurgery department from January 2018 to January 2023. A preoperative magnetic resonance examination of the patients revealed the presence of abnormally located vascular compression in the rostral ventrolateral medulla (RVLM) and the root entry zone (REZ) of the IX and X cranial nerves (CN IX- X). There was no significant difference between the two groups in terms of gender, age, course of HFS, course of TN, course of HTN, degree of HTN, or preoperative blood pressure. Based on the postoperative blood pressure levels, nine out of 63 patients were cured (14.28%), eight cases (12.70%) showed a marked effect, 16 cases (25.40%) were effective, and 30 cases were invalid (47.62%). The overall efficacy was 52.38%. However, 39 cases of combined cranial nerve disease were on the left side of the efficacy rate (66.67%) and 24 cases of combined cranial nerve disease were on the right side of the efficacy rate (29.16%). Over the last few decades, many scholars have made pioneering progress in the clinical retrospective study of MVD for neurogenic hypertension, and our study confirms the efficacy of MVD in treating vertebral/basilar artery-type neurogenic hypertension by relieving the vascular pressure of RVLM. In the future, with the development and deepening of pathological mechanisms and clinical observational studies, MVD may become an important treatment for neurogenic hypertension by strictly grasping the surgical indications. MVD is an effective treatment for neurogenic HTN. Indications may include the following: left-sided TN or HFS combined with neurogenic HTN; VA/BA compression in the left RVLM and REZ areas on MRI; and blood pressure in these patients cannot be effectively controlled by drugs.

The effects of fibroblast growth factor-23 on diagnosis of cerebral infarction and vertebral basilar artery stenosis☆

ObjectivesThis study aimed to explore the correlation between Fibroblast Growth Factor-23 (FGF23) levels and Cerebral Infarction (CI), and to determine whether there is a significant relationship between FGF23 and the occurrence and severity of CI. MethodsThe study categorized Cerebral Infarction (CI) patients into severe and mild stenosis groups based on vertebrobasilar artery stenosis, using Digital Subtraction Angiography (DSA) and Magnetic Resonance Imaging (MRI). The study compared the levels of Fibroblast Growth Factor-23 (FGF23) in the serum of CI patients and healthy controls using a t-test and evaluated the diagnostic effectiveness of serum FGF23 using a Receiver Operating Characteristic (ROC) curve. Additionally, the study analyzed the correlation between FGF23 levels and CI severity after treatment using the National Institute of Health Stroke Scale score. ResultsThe study found a significant increase in serum Fibroblast Growth Factor-23 (FGF23) levels in patients with Cerebral Infarction (CI) compared to healthy volunteers, (p < 0.001). A higher serum FGF23 level was observed in the severe stenosis group than in the mild stenosis group (p < 0.001). Furthermore, the study showed that a high FGF23 level at admission was significantly related to more severe symptoms of CI as indicated by the National Institute of Health Stroke Scale (NIHSS) score on the 7th day after treatment (p < 0.001). ConclusionsThis study discovered a correlation between Fibroblast Growth Factor-23 (FGF23) levels, vertebrobasilar artery stenosis, and short-term prognosis in patients who had recently experienced acute Cerebral Infarction (CI).

A Comparative Study of the Etiology of Intracranial Vertebral Artery Dissection and Carotid Artery Dissection.

Both extrinsic (trauma or violent movement) and intrinsic (structural abnormality, atherosclerosis, or hemodynamic instability) factors may result in arterial dissection. The role of these factors in the origin or progression of dissection remains unclear. This study aimed to characterize the clinical features, radiologic features, and outcomes of intracranial vertebral artery dissection compared with carotid artery dissection and to determine the major causative factors. Consecutive patients with craniocervical dissection (n=127) were retrospectively analyzed. Patients with intracranial vertebral artery dissection (n=77) and those with carotid artery dissection (n=35) were compared with respect to patient age, sex, cerebrovascular risk factors, laboratory indices, and radiologic features. Intracranial vertebral artery dissection was the most common craniocervical arterial dissection in our cohort (n=77, 60.6%). Body mass index in the intracranial vertebral artery dissection group was significantly greater than that in carotid artery dissection group. Clinical manifestations of intracranial vertebral artery dissection included ischemic stroke (37.7%), dizziness or vertigo (39.0%), and headache or neck pain (44.2%). Two patients had a definite history of trauma. The frontal and lateral tortuosity ratios of the vertebral basilar artery were significantly greater while the vertex angle was smaller in the intracranial vertebral artery dissection group compared with carotid artery dissection group. A positive correlation between the tortuosity ratios and subarachnoid hemorrhage and a significant inverse correlation between the tortuosity ratios and lipid parameters (high-density lipoprotein; apolipoprotein A1) were identified. Intrinsic causes may play a more important role in the development of intracranial vertebral artery dissection than carotid artery dissection.

Predictive Value of a Novel Baseline Diffusion-Weighted Imaging Posterior Circulation Score in Endovascular Treatment of Patients with Acute Vertebrobasilar Occlusion

To investigate the predictive value of a novel posterior circulation score (novel-PC score) based on baseline posterior circulation diffusion-weighted imaging (DWI) for functional independence after endovascular treatment (EVT) in patients with acute vertebral-basilar artery occlusion (VBAO). The baseline DWI brain stem score (BSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), and the novel-PC score were evaluated separately. A modified Rankin scale(mRS) ≤2 at 90 days was defined as a prognostic indicator of functional independence. Modified Thrombolysis in Cerebral Infarction grade 2b or 3 was defined as surgical success. A total of 64 eligible patients were enrolled and divided into good and poor functional prognosis groups based on the mRS. The novel-PC score, BSS, and pc-ASPECTS (all P≤.001) were significantly better in the good functional prognosis group. The novel-PC score had a higher predictive value than BSS and pc-ASPECTS for 90-day functional independence (area under the receiver operating characteristic curve, 0.87 vs. 0.73 vs. 0.71; P<.05). Univariate binary logistic regression analysis showed that age (P=.006), Posterior National Institutes of Health Stroke Scale ≤18 (P<.001), BSS ≤2 (P=.008), pc-ASPECTS >7 (P=.002), and novel-PC score ≤5 (P=.001) were independently associated with function. Our novel-PC score, based on DWI, can independently predict functional prognosis in patients with acute VBAO after EVT. The novel-PC score based on baseline DWI was shown to be an independent predictor of function in patients with acute BVAO who are treated with EVT.

Single-center experience of endovascular treatment for patients with progressive posterior circulation cerebral infarction exceeding 24 h.

Evidence of endovascular treatment (ET) for patients with progressive infarction of the posterior circulation exceeding 24 h is lacking. To evaluate the efficacy and safety of ET for progressive posterior circulation cerebral infarction. This retrospective study evaluated the ET for 18 patients with posterior circulation infarction caused by vertebrobasilar artery occlusion from July 2017 to November 2018. The conditions of patients worsened despite receiving intravenous thrombolysis or combination therapy with clopidogrel and aspirin. The time from the onset of cerebral infarction to puncture was >24 h. The preoperative National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and related risk factors of patients at 3 months were analyzed postoperatively. The preoperative NIHSS score was 10.6 (IQR: 6.5), and the time from onset to puncture was 163.5 ± 144.7 h. Postoperative blood flow was modified thrombolysis in cerebral infarction (mTICI) grade 2b or above. During the follow-up period, 1 patient died of basilar artery re-occlusion and pulmonary infection, and 1 died of postoperative hyperperfusion hemorrhage, with a mortality rate of 11.1% (2/18). No recurrent ischemic events were observed in any of the 16 patients during the 3-month follow-up period. The mean mRS score was 1.3 (IQR: 2.3), and 75% patients (12/16) had an mRS score of 0-2. There were no significant differences in age, gender, clinical characteristics, and stroke subtype between patients with mRS scores ≤2 and >2. In patients with progressive posterior circulation cerebral infarction caused by vertebral basilar artery occlusion, ET is effective and safe even if the time from onset to puncture exceeds 24 h.

Natural history of acute unruptured vertebral basilar artery dissection: Temporal changes in imaging findings and contributory factors

ObjectivesTo investigate temporal changes in imaging findings of conservatively treated acute unruptured vertebral basilar artery dissection (VBAD) and its contributing factors. MethodsFifty-three patients who underwent conservative treatment for 64 cases of acute VBAD diagnosed between January 2006 and March 2019 with follow-up of at least 12 months after onset were retrospectively investigated. Statistical analyses of age, sex, medical history, pattern of onset, lesion site, imaging findings and changes over time, regular medication, and outcomes were performed. ResultsChanges in the vascular morphology of the lesion site during the follow-up period were observed in only 23 (43 %) patients (median time until change: 19 days). Univariate analysis of factors contributing to morphological changes at the dissection site showed that changes were significantly more likely in younger patients (p = 0.011). Patients taking antiplatelet drugs had a significantly greater rate of deterioration at the dissection site (p = 0.028) than others. On multivariate analysis, age was an independent factor contributing to changes at the dissection site, and taking antiplatelet drugs, particularly clopidogrel, was an independent factor contributing to deterioration. No patient developed intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during follow-up. ConclusionsMorphological changes at the dissection site are more likely in younger patients with acute unruptured VBAD and those taking antiplatelet drugs. However, chances of intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during conservative therapy are low; therefore, acute unruptured VBAD may be considered a benign condition.

Effect of balance acupotomy combined with warm needling in treatment of cervical spondylosis of vertebral artery type

To observe the clinical efficacy of balance acupotomy combined with warm needling in treatment of cervical spondylopathy of vertebral artery type (CSA). Ninety patients were randomly divided into a warm needling group, a balance acupotomy group and a combined treatment group, 30 cases in each one. In the warm needling group, warm needling was given, once daily, for 5 days consecutively, with the interval of 2 days every week, and the treatment was conducted for 3 weeks. In the combined treatment group, on the base of the treatment as the warm needling group, the balance acupotomy was exerted, for consecutive 3 weeks. In the balance acupotomy group, the balance acupotomy was adopted, once a week, for 3 weeks consecutively. Clinical efficacy, the mean blood flow velocity of left vertebral artery (LVA), right vertebral artery (RVA) and basilar artery (BA), the pulse index (PI) and the resistance index (RI) were observed in 3 groups separately. The score of vertigo symptom and function was compared before and after treatment in 3 groups. In comparison with before treatment, the score of evaluation scale for cervical vertigo (ESCV) and the mean blood flow velocity of LVA, RVA and BA were all increased (P<0.05). while PI and RI reduced (P<0.05) in each group after treatment. In comparison with those in the warm needling group and the balance acupotomy group, ESCV score and the mean blood flow velocity of LVA, RVA and BA were increased (P<0.05), while PI and RI decreased (P<0.05) in the combined treatment group after treatment. Compared with the balance acupotomy group, the mean blood flow velocity of LVA, RVA and BA was increased (P<0.05), and PI and RI reduced (P<0.05) in the warm needling group after treatment. The total effective rate was 73.3% (22/30) in the warm needling group, 70.0% (21/30) in the balance acupotomy group and 93.3% (28/30) in the combined treatment group respectively. The total effective rate in the combined treatment group was higher than that either in the warm needling group or in the balance acupotomy group (P<0.05). Balance acupotomy combined with warm needling may restore the mechanical equilibrium state of the neck, and effectively improve the change of vertebral-basilar artery blood flow and relieve vertigo symptoms in patient with of cervical spondylosis of vertebral artery type.

Cervical Sprain With Residual C1-C2 Laxity as Source of Fibromyalgia and Multiple Sclerosis Symptoms?

Research Objectives To evaluate the upper cervical segmental mobility in patients with a remote history of trauma presenting with persistent fibromyalgia symptoms with evidence of persistent cervical sprain pain. Design Chart review. Setting Outpatient clinic. Participants Patients with history diagnosed with fibromyalgia and demonstrating (1) frequent headache on awakening, (2) pain/increased symptoms with neck range of motion, (3) pain with resistance to neck motion, (4) relief during cervical traction, (5) and typical fibromyalgia symptoms. Interventions CT of the cervical spine including rotation views. Main Outcome Measures Skeletal mobility per CT scan including Cranium, C1, and C2 rotation in degrees Results Analysis reveals that only one of the individuals had < 30 degrees rotation of C1 on C2, versus 14 of 20 having > 35 degrees and 7 of 20 having > 40 degrees rotation of C1 on C2 suggesting ligamentous laxity. Of note, none of the individuals had > 5 degrees rotation of cranium on C1, suggesting greater stability when compared to C1-C2. Conclusions In addition to upper spinal cord, the vertebral-basilar arteries supply the cerebellum, medulla oblongata, midbrain, pons, thalamus, and other areas in the posterior cranium. Symptoms of ischemia involving these areas include dizziness, gait disturbance, limb weakness, dysarthria, headache, nausea, cranial nerve, visual and other sensory dysfunctions. This sampling of persistent neck pain patients demonstrates significant rotational mobility that may involve the vertebral arteries at C1 and C2 in particular, contributing to symptoms similar to those with documented ischemia in the vertebrobasilar distribution. Alternatively, direct compression at cervical spinal cord-medullary junction from C1-2 laxity is illustrated in sagittal view MRI image. Here is seen anterior cranial migration relative to spinal canal compressing the spinal cord at its medullary junction. It is noteworthy that 4 individuals in this small sample developed plaque in the vertebrobasilar distribution and subsequently confirmed to have multiple sclerosis. Whether or not there is a relationship between ligamentous laxity in the upper cervical spine and development of fibromyalgia and/ or multiple sclerosis remains to be demonstrated. Author(s) Disclosures None to declare. To evaluate the upper cervical segmental mobility in patients with a remote history of trauma presenting with persistent fibromyalgia symptoms with evidence of persistent cervical sprain pain. Chart review. Outpatient clinic. Patients with history diagnosed with fibromyalgia and demonstrating (1) frequent headache on awakening, (2) pain/increased symptoms with neck range of motion, (3) pain with resistance to neck motion, (4) relief during cervical traction, (5) and typical fibromyalgia symptoms. CT of the cervical spine including rotation views. Skeletal mobility per CT scan including Cranium, C1, and C2 rotation in degrees Analysis reveals that only one of the individuals had < 30 degrees rotation of C1 on C2, versus 14 of 20 having > 35 degrees and 7 of 20 having > 40 degrees rotation of C1 on C2 suggesting ligamentous laxity. Of note, none of the individuals had > 5 degrees rotation of cranium on C1, suggesting greater stability when compared to C1-C2. In addition to upper spinal cord, the vertebral-basilar arteries supply the cerebellum, medulla oblongata, midbrain, pons, thalamus, and other areas in the posterior cranium. Symptoms of ischemia involving these areas include dizziness, gait disturbance, limb weakness, dysarthria, headache, nausea, cranial nerve, visual and other sensory dysfunctions.

Curative Effect of Interventional Therapy and Neurological Changes in Ischemic Stroke of Posterior Circulation Evaluated by Magnetic Resonance Imaging under Genetic Algorithm

Objective. This study aimed to evaluate the improvement and neurological function changes of patients with ischemic stroke in the posterior circulation before and after interventional therapy using magnetic resonance imaging (MRI) under genetic algorithm and compressed sensing algorithm. Methods. Thirty-six patients with posterior circulation ischemia who visited the interventional cerebrovascular disease area were included in this study. The treatment effect was observed through abnormal signal changes in the lesion area on each sequence of MRI images before and after treatment. The National Institutes of Health Stroke Scale (NIHSS) was used for the evaluation of the changes in neurological function. Results. The real data experiment results suggested that the peak signal-to-noise ratio (PSNR) = 39.33 and structure similarity (SSIM) = 0.96 in the algorithm reconstructed image, which showed no significant difference with the simulation experiment results of PSNR = 35.19 and SSIM = 0.96 ( P &lt; 0.05 ). In addition, the stenosis rate after interventional treatment (13.89%) was substantially lower than that before treatment (91.67%) ( P &lt; 0.05 ). Cerebral blood flow (CBF) of the bilateral occipital lobes and cerebellum after six months of treatment was higher than that before treatment ( P &lt; 0.05 ), and the incidence of postoperative restenosis was 11.11% (4/36). Conclusion. The combination of genetic algorithm and compressed sensing algorithm had a good effect on MRI image processing. The posterior circulation ischemia interventional stent implantation can effectively improve the stenosis of the vertebral artery and vertebral basilar artery as well as the cerebral tissue perfusion in the ischemic area, which improved the clinical symptoms substantially and reduced the probability of restenosis.

Effect Of Butylphthalide Combined with Ozagrel Sodium on Cerebral Perfusion and Oxidative Stress Indexes in Patients with Transient Ischemic Attack

Background The pathogenesis of transient ischemic attack is not clear. Microthrombosis theory is a theory with high clinical recognition. Microthrombosis of carotid artery and vertebral basilar artery wall occurs shedding and vasospasm, resulting in transient cerebral insufficiency. Microembolic decomposition or distal movement, cerebrovascular dilatation, local collateral circulation after the establishment of symptoms relieved or disappeared. Most patients can be relieved in a short time, but recurrent attacks can gradually damage the structure and function of brain tissue, and increase the risk of acute cerebral infarction. The clinical treatment of this disease is mainly based on the comprehensive control of risk factors, anti thrombosis, and anti-platelet aggregation. Objective To observe the effect of butylphthalide combined with ozagrel sodium on cerebral perfusion and oxidative stress indexes in patients with transient ischemic attack. Methods A total of 116 patients diagnosed as transient ischemic attack in our hospital (February 2018 - February 2020) were selected and divided into two groups according to the treatment methods. 58 cases in the control group were treated with ozagrel sodium, 58 cases in the observation group were treated with butylphthalide combined with ozagrel sodium. The CT perfusion imaging parameters, oxidative stress indexes, plaque area, and the levels of platelet activating factor ( PAF ), α-granule membrane protein-140 ( GMP-140 ), fibrinogen ( FIB ), platelet aggregation rate (PAgT), neuron-specific enolase (NSE), oxygend-inducible factor-1α (HIF-1α), and matrix metalloproteinases 9 (MMP-9) in the two groups were recorded, and the total effective rate and adverse reaction rate were counted. Results The total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (χ2=4.640, P = 0.031). Compared with before treatment, the average time (MTT) required for the two groups of contrast agents to pass through the local brain tissue and the time (TTP) required to start the injection of contrast agents to reach the peak concentration decreased compared with before treatment. After treatment, the MTT and TTP of the observation group were shorter than those of the control group (P &lt; 0.05). Compared with before treatment, superoxide dismutase ( SOD ) in the two groups was higher than that in the control group, PAF, GMP-140, FIB, PAgT, NSE, HIF-la, MMP-9, malondialdehyde (MDA) and plaque area decreased. After treatment, the levels of related factors in the observation group were better than those in the control group, and the plaque area was less than that in the control group (P &lt; 0.05). There was no significant difference in the adverse reaction rate between the observation group and the control group (χ2 = 0.438, P=0.508). Conclusion Butylphthalide combined with ozagrel sodium in the treatment of transient ischemic attack can improve cerebral perfusion, reduce oxidative stress injury, reduce plaque and improve curative effect.

A Direct Aspiration First Pass Technique for Vertebra-Basilar Occlusion: A Retrospective Comparison to Stent Retriever

ObjectivesThis study aimed to assess the clinical usefulness of a direct aspiration first pass technique as a first-line strategy for mechanical thrombectomy in posterior circulation. Materials and methodsWe examined 34 consecutive patients treated with mechanical thrombectomy for acute vertebrobasilar artery occlusion. Procedural and clinical outcomes were assessed and compared between patients treated with a direct aspiration first pass technique first-line strategy (ADAPT group) and stent retriever system first-line strategy (stent retriever group). ResultsOverall, successful reperfusion, complete reperfusion, and first-pass effects were achieved in 94.1%, 61.8%, and 50% of patients with acute ischemic stroke in vertebra-basilar artery occlusion treated with mechanical thrombectomy, respectively. The ADAPT group required a significantly shorter procedural time (p=.015) and fewer attempts (p=.0498) to achieve successful recanalization than the stent retriever group. The ADAPT group also tended to show better recanalization rates and first-pass effects than the stent retriever group. The rates of favorable outcomes seemed to be better, although insignificant, in the ADAPT group than in the stent retriever group (52.2% vs. 27.3%, p=.217). However, a significant correlation between the time required for reperfusion and clinical outcome was detected, and this will serve as the rationale for encouraging a direct aspiration first pass technique as a first-line strategy in the acute vertebra-basilar artery. ConclusionsThe a direct aspiration first pass technique first-line strategy for mechanical thrombectomy in posterior circulation may achieve successful recanalization with fewer attempts and shorter durations than the stent retriever first-line strategy.

Stenting for Symptomatic Intracranial Vertebrobasilar Artery Stenosis in Northeast of China: A Single-Center Study.

Objective: We described the incidence of surgery-related complications to evaluate the safety of endovascular therapy for severe symptomatic intracranial vertebral basilar artery stenosis (IVBS) in our stroke center in Northeast of China.Methods: Consecutive patients with symptomatic IVBS caused by 70–99% stenosis despite standard medical treatment of antiplatelet agents plus statin were enrolled. Either balloon-mounted stent or balloon predilation plus self-expanding stent was performed. Clinical adverse events such as stroke, transient ischemic attack (TIA), and death after the surgery were documented. Radiological events such as in-stent thrombosis, dissection, and guide-wire perforation during the process were recorded as complications as well. The baseline characteristics and outcomes of patients among different Mori types were compared.Results: From January 2017 to December 2018, 97 patients with stroke or TIA due to intracranial IVBS were treated by stenting, including 30 patients with basilar artery (BA) stenosis, 55 patients with intracranial vertebral artery (V4) stenosis, and 12 patients with V4-BA stenosis. The primary events include two intracranial hemorrhage (2.1%, 2/97), seven ischemic events (7.2%, 7/97), and two death (2.1%, 2/97). The successful stent deployment rate was 98.9% (96/97). The Apollo stents were used more for Mori A lesions. Self-expanding stents were more used in Mori C lesions. Mori C lesions were more vulnerable to endovascular procedure and showed higher rate of complications than A (p = 0.008) and B type (p = 0.047).Conclusion: A high technical success rate of IVBS stenting could be achieved, and the safety was acceptable, whereas Mori C lesions were more vulnerable to endovascular procedure and showed a higher rate of complications than A and B types.

Meta analysis of treatment efficacy for posterior circulation ischemic vertigo using therapy for elevating Yang

Objective: To evaluate the clinical efficacy of TCM therapy for elevating Yang in the treatment of posterior circulation ischemic vertigo. Methods: all clinical randomized controlled trials of therapy for elevating Yang's posterior circulation ischemic vertigo were screened by computer searching Chinese databases such as CNKI, Wanfang database, VIP Chinese science and technology and the Cochrane Library, PubMed, EMBASE and other English databases from the time the library was built to October 2020, and relevant references were manually reviewed. Patients in the control group were treated with western medicine, while those in the experimental group were treated with either Elevating Yang recipe (decoction) or Elevating Yang recipe (decoction) combined with western medicine. The Review Manager 5.3 software was used to conduct a meta-analysis on the clinical effective rate, TCM syndrome scores, vertebrobasilar blood flow velocity, and adverse reactions. Results: Eleven articles were finally included, covering a total of 1049 patients, including 522 cases in the observation group and 527 cases in the control group. The clinical effective rate of patients in the experimental group is higher than that in the control group [RR=1.22(1.16,1.28)], the vertebral-basilar artery blood flow velocity in the experimental group includes left vertebral artery (LVA) [MD = 4.88, 95%CI(3.30, 6.46)], right vertebral artery (RVA) [MD = 4.87, 95%CI(2.85, 6.88)], and basilar artery (BA) [MD = 5.17. 95%CI(4.55, 5.78)], TCM symptom scores significantly improved in the experimental group [MD = -4.17, 95%CI(-4.66, -3.67)], the difference was statistically significant. Conclusion: The results of this meta-analysis indicated that Therapy for Raising Yang had good therapeutic effects on CI after treatment, in that it could effectively improve the clinical efficiency, promote the blood flow velocity of vertebrobasilar artery, and reduce TCM symptom scores. However, it still needs to be further confirmed by large sample size and high quality RCTs.

Endovascular revascularization of chronically occluded vertebral artery: single-center experience.

IntroductionChronic vertebral basilar artery occlusion is one of the most common causes of ischemic stroke, which accounts for roughly 20% of all cases. However, the evidence for the precise clinical effect in treatment of the initial segment of chronic vertebral basilar artery occlusion is not sufficient.AimTo evaluate the feasibility and efficacy of endovascular therapy in the initial segment of chronic vertebral basilar artery occlusion.Material and methodsThis is a retrospective study based on data obtained from Lishui Hospital of Zhejiang University. We identified patients who underwent treatment for initial segment occlusion of the vertebral basilar artery from September 2014 to September 2018.ResultsAmong a total of twenty-two subjects, 77.27% of them were men and the median age was 61 years old. The primary medical history of these patients included hypertension (15, 68.18%), hyperlipidemia (13, 59.09%), diabetes mellitus (11, 50.00%), and coronary artery disease (6, 27.27%). About 54.54% of the patients were current smokers. Successful recanalization was achieved in 86.36% of patients. Five cases of balloon dilatation were recanalized and fourteen cases were treated by balloon dilation combined with stent implantation. During the follow-up period, there were no recurrent cerebral ischemic events, including transient ischemic attack or stroke. Six (27.27%) arteries were found to exhibit angiographic re-stenosis.ConclusionsThe clinical effect of balloon dilatation or balloon dilatation combined with stenting in the treatment of chronic vertebral basilar artery occlusion in the beginning segment was feasible and safe.

Characteristics of Clinical Symptoms, Cerebral Images and Stroke Etiology in Vertebro-Basilar Artery Fenestration-Related Infarction.

Cerebral artery fenestration is a rare variant of the vascular architecture, but its existence is well documented. The common site of fenestration is the vertebra-basilar artery and it may be found incidentally with subarachnoid hemorrhage. However, fenestration-related cerebral infarction is rare. We analyzed the clinical characteristics, stroke etiology, and image findings of fenestration-related cerebral infarction of the vertebrobasilar artery. We reviewed our hospital records and previously published reports to find cases of fenestration-related cerebral infarction. We excluded those with unknown clinical features or radiological findings. We retrieved 4 cases of fenestration-related infarction from our hospital, in which vascular change, headache, vertigo/dizziness, and dissection in stroke etiology were detected. In eight previously reported cases of fenestration-related infarction, similar vascular changes were noted, but they were mainly diagnosed as embolic stroke of undetermined source. However, based on the criteria for dissection in this study, dissection as the stroke etiology was suspected in the previously reported cases. Many hypotheses have been proposed for the development of dissection, thrombus, and aneurysms in fenestration. Although an embryological and morphological study is needed, clinicians must consider basilar artery fenestration-related infarction as a differential diagnosis and intensive non-invasive image study is recommended.

Tokyo Metropolitan Stroke Emergency Medical Services for Interventional Stroke Treatment: The Tama-REgistry of Acute Thrombectomy (TREAT) Study

ObjectiveIt is not clear how patients with large vessel occlusion (LVO) who have undergone mechanical thrombectomy (MT) were transported to hospitals by emergency medical services. Here, we describe the current status of the stroke delivery system in a large city. MethodsWe investigated data from 328 patients (male, n = 199; average age, 74.8 ± 12.9 years) who underwent MT at 12 facilities in the Tama area of Tokyo, between January 2015 and December 2017. The patients were classified according to the destination institution as Stroke A eligible (group A, n = 266 [8.2%]), Tertiary critical care center (group T; n = 35 [10.7%]), and other destinations such as emergency rooms (group O; n = 27 [8.2%]), and then reasons for using Emergency Medical Service (EMS) services and outcomes were compared among the groups. ResultsRates of milder stroke, and middle cerebral artery occlusion were significantly higher in group A than T, whereas that of vertebral-basilar artery occlusion was significantly lower in group A than in groups T and O. The amount of elapsed time from door to picture (DTP) was significantly lower in group A. The time from onset to recanalization, as well as rates of successful recanalization and favorable outcomes (90-day modified Rankin scale 0-2) did not significantly differ regardless of destination. ConclusionsMost patients with LVO in the Tama area were categorized into group A. DTP was significantly lower in group A.

Clinical value of transcranial Doppler ultrasonography combined with carotid ultrasonography in the diagnosis of vertebral-basilar artery stenosis

Objective To investigate the clinical value of transcranial Doppler ultrasound(TCD) combined with carotid ultrasound in the diagnosis of vertebral-basilar artery stenosis. Methods From March 2016 to December 2018, 147 patients with suspected vertebrobasilar artery stenosis admitted to the People's Hospital of Zhuji were selected.TCD combined with carotid artery ultrasonography were used to diagnose vertebrobasilar artery stenosis, and X-ray computed tomography angiography (CTA) was performed.The diagnostic accuracy of TCD combined with carotid artery ultrasonography for vertebrobasilar artery stenosis was analyzed based on the results of CTA. Results The diagnostic value of TCD combined with carotid ultrasound for vertebrobasilar artery stenosis was analyzed by using CTA as diagnostic gold standard.The diagnostic sensitivity for left vertebral artery was 86.42%, specificity was 89.39%, positive predictive value was 90.91%, negative predictive value was 84.29%.The diagnostic sensitivity for right vertebral artery was 80.26%, specificity was 90.14%, positive predictive value was 89.71%, negative predictive value was 81.01%.The sensitivity, specificity, positive predictive value and negative predictive value for basilar artery were 81.69%, 93.42%, 92.06% and 84.52%.respectively.There were no statistically significant differences between TCD combined with carotid ultrasound and CTA in the diagnosis of left vertebral artery, right vertebral artery and basilar artery stenosis (Z=-0.360, -0.851, -0.828, all P>0.05). Conclusion TCD combined with carotid ultrasonography is an effective screening method for patients with vertebrobasilar artery stenosis, which is helpful to the detection of patients' condition and the guidance of clinical treatment, and is worthy of clinical application. Key words: Ultrasonography, doppler, transcranial; Ultrasonography, doppler, color; Basilar artery; Vertebral artery; Carotid arteries; X-ray computed tomography angiography; Intracranial atherosclerotic stenosis