It is one of the posterior circulation infarctions. To provide more data on the outcome of conventional treatment. Listing a study does not mean it has been evaluated by the u. The normal basilar artery imaged on plain ct scans has an attenuation value not higher than that of whole blood. Basilar artery occlusion is a most devastating form of stroke, and the current practice is to. Basilar artery occlusion bao is one of the most devastating forms of stroke and few patients have good outcomes without recanalization. The basilar artery is joined to the brainstem via penetrating median, paramedian, and short and long circumferential branches, 21 which are connected by anastomotic channels in 4267% of people. Basilar artery occlusion bao is a rare cause of stroke, occurring in about 1% of all the cases. Mechanical thrombectomy for basilar artery occlusion. Basilar artery occlusion chinese endovascular trial full.
Endovascular clot retrieval ecr is an emerging therapy for treatment of acute ischaemic stroke ais in adults, including basilar artery occlusion bao. Acute stroke caused by basilar artery occlusion bao has devastating effects on patients. Case report a vertebral artery dissection with basilar artery. It carries a high mortality of 8595% if recanalization does not occur, and a substantial part of survivors suffer severe disability, some being in locked in state. Dense artery sign of the basilar artery a intraluminal lling defect in basilar artery axial view with contrast medium b coronal view with contrast medium occlusion of basilar artery between arrows, thin caliber of right superior cerebellar artery with a little thrombus at. They are associated with very poor outcomes and high mortality. There are several technical considerations pertinent to this scenario. To report on the early clinical features and patterns of. Temporary balloon occlusion during the surgical treatment of giant paraclinoid and vertebrobasilar aneurysms.
It is due to the thromboembolic occlusion of the top of the basilar artery. Basilar artery occlusion was diagnosed by highresolution computed tomography ct in 11 cases. The clinical presentation of basilar artery occlusion bao ranges from mild transient symptoms to devastating strokes with high fatality and morbidity. The average length of the clinical course of the disease was five months. Occlusion of the basilar artery is one of the most devastating forms of ischemic stroke. We report a case of an acute basilar artery occlusion presenting with decreased level of consciousness associated with rhythmic tonic movements of the four extremities.
Strokes caused by basilar artery occlusion are uncommon, with around 10% of large vessel strokes being basilar 1. Mechanical thrombectomy in subtypes of basilar artery. Outcome in patients with basilar artery occlusion treated. Mechanical thrombectomy of acute basilar artery occlusion. Temporary balloon occlusion of a proximal vessel as an aid to clipping aneurysms of the basilar and paraclinoid internal carotid arteries. The authors present an uncommon acute basilar occlusion secondary to a fusiform aneurysm with intraluminal thrombus. The first page of the pdf of this article appears above. Basilar artery occlusion bao is a potentially fatal diagnosis, yet it is one of the most challenging conditions for clinicians to diagnose and manage. Endovascular clot retrieval for acute ischaemic stroke due. Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intraarterial thrombolysis.
It is a true neurointerventional emergency and, if not treated early, brainstem infarction results in rapid deterioration in the level of consciousness. Stroke or transient ischemic attacks with basilar artery. Acute occlusion of the basilar artery may cause brainstem or thalamic ischemia or infarction. In this speculative synthesis, we discuss recent advances in. Often, nonspecific prodromal symptoms such as vertigo or headaches are indicative of bao, and are followed by the hallmarks of bao, including decreased consciousness, quadriparesis, pupillary and oculomotor abnormalities, dysarthria, and. Endovascular management of basilar artery occlusion. Outcomes of endovascular treatment of basilar artery. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients.
Thus there is little information about the initial phase of the disease. Background stent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion bao is unclear. Given that the right vertebral artery is dominant, this is likely the most favorable access point to attempt thrombectomy. Background basilar artery occlusion bao is associated with a high mortality rate, although cases with spontaneous favorable outcomes have recently been reported, and basilar artery stenosis bas has received little consideration until now objective to study the prognostic clinical factors by testing numerous combinations of admission status characteristics of patients with brain. Intraarterial thrombolysis may improve overall outcome in patients with basilar artery occlusion, 1,2 but predicting benefit from therapy is still difficult in individual patients. Bao is characterized by bad prognosis and high death rate, which is about 7591%. Introduction acute basilar artery occlusion bao is associated with a very poor outcome and has the highest mortality rate among intracranial largevessel occlusions 1,2. Intravenous thrombolysis and localintra arterial thrombolysis are the most common. Acute occlusion of the basilar artery with coma is a neurologic emergency with an associated poor prognosis. A presumptive diagnosis can be made during the clinical assessment, but imaging studies are needed in order to. The outcome and mortality associated with bao are worse than those associated with anterior circulation stroke. Original research article recanalization treatments in basilar artery occlusionsystematic analysis perttu j lindsberg1,2, tiina sairanen1, simon nagel3, oili salonen4, heli silvennoinen4 and daniel strbian1 abstract background and aims. Nov 17, 2015 basilar artery occlusion bao is one of the most devastating forms of stroke and few patients have good outcomes without recanalization. Magnetic resonance imaging in basilar artery occlusion.
It is the main blood vessel that forms the posterior circulation of the brain this is one of two arterial circuits the other being the anterior circulation that delivers up to 15% of the total cardiac output to the brain tissue. Endovascular thrombectomy for acute basilar artery. Pontine syndromes reflect the particular structures affected, with a. Eventually, quadriparesis, dysarthria, altered level of consciousness, and ocular abnormalities may ensue and put the patient at great risk. Qestion 2 time window for recanalization in basilar artery occlusion. The use of noninvasive imaging such as magnetic resonance imaging and. Dense artery sign of the basilar artery a intraluminal lling defect in basilar artery axial view with contrast medium b coronal view with contrast medium occlusion of basilar artery between arrows, thin caliber of right superior cerebellar artery with a little thrombus at the ostium, and associated occlusion o f. Importance after the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion bao. This high demand for oxygenated blood is based on the diverse. Basilar artery occlusion is a most devastating form of stroke, and the current practice is to reverse it with revascularization therapies. Basilar artery occlusion is a devastating but treatable form of ischaemic stroke with high morbidity and mortality rates. Endovascular treatment for acute basilar artery occlusion. Basilar artery occlusion is assumed to carry a grave prognosis, with mortality rates of up to 90%.
Acute basilar artery occlusion bao is associated with a very poor outcome and has the highest mortality rate among intracranial largevessel occlusions. Occlusion of the basilar artery is a neurologic emergency that requires a rapid diagnostic evaluation and subsequent therapy. Mattle hp, arnold m, lindsberg pj, schonewille wj, schroth g. Basilar artery stroke is most commonly caused by atherothrombosis and cardio embolism. Objective to compare patients outcome, relative merits of achieving recanalization, and predictors of futile recanalization fr between bao and anterior circulation large vessel occlusion aclvo mt. Pdf safety and outcome of intraarterial treatment for. Oct 08, 2016 qestion 2 time window for recanalization in basilar artery occlusion. Jul 01, 2015 top of the basilar artery syndrome is also known as a rostral brainstem infarction. Basilar artery occlusion chinese endovascular trial the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Top of the basilar artery syndrome is also known as a rostral brainstem infarction. The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. Case report a vertebral artery dissection with basilar.
Basilar artery occlusion was found in one in every 160 autopsies. This is probably partially owing to the fact that tissue injury in critical brainstem. Most centers apply recanalization therapies for bao up to 1224 hours after symptom onset, which is a substantially longer time window than the 4. Risk factors for the thrombosis are hypertension 1, diabetes mellitus 2, obesity 2, hyperhomocystinemia 3, and. This study aims to determine the characteristics and treatment outcomes of patients with acute basilar artery occlusion bao and to evaluate the effectiveness and safety of evt for.
The authors assessed the clinical outcome of patients who had basilar artery occlusion after intravenous thrombolysis with or without subsequent intraarterial thrombolysis ivt, antithrombotic treatment, and intraarterial therapy iat in a. A traditional recanalization approach based on historical controls and pathophysiological consideration is local intraarterial thrombolysis iat in eligible patients. Information on how to subscribe to neurology and neurology. Translamina terminalis approach assisted by endovascular. The diagnosis is often challenging due to considerable heterogeneity of clinical signs and symptoms. The clinical manifestations of basilar artery occlusive disease vary according to the site and nature of vascular compromise. Time window for recanalization in basilar artery occlusion. Risk factors for the thrombosis are hypertension 1, diabetes mellitus 2, obesity 2, hyperhomocystinemia 3, and excessive alcohol intake. Basilar artery occlusion occlusion and stenosis of. Posterior circulation strokes account for about 15% to 20% of all ischemic strokes. The heart and vertebral arteries are the main source of emboli in embolic basilar occlusions. The pathogenesis of occlusion can be secondary to both local atherothrombosis or cardioembolism. Patient presents with decreased consciousness e1m2v1, fever 40. Vertebrobasilar artery occlusion the western journal of.
There are a number of different pathophysiological mechanisms, including atherosclerosis, embolism, dissection and inflammation 3. Many patients had a history of hypertension, diabetes mellitus, and cerebrovascular attacks. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Background and purpose basilar artery occlusion bao is an infrequent form of acute stroke, which invariably leads to death or longterm disability if not recanalized. Basilar artery occlusion is a lifethreatening vascular pathology that can initially present with relatively mild and nonspecific symptoms. Pharmacological thrombolysis, intravenous or intraarterial, has been adjuncted or replaced with invasive, endovascular thrombectomy procedures. We report four consecutive children with ais due to bao treated with ecr in sydney, australia.
Treatment and outcomes of acute basilar artery occlusion in the basilar artery international cooperation study basics. The most common causes include embolism, largeartery atherosclerosis, penetrating smallartery disease, and arterial dissection. Heralding manifestations of basilar artery occlusion with. The neurological signs and symptoms of basilar artery occlusion extremely varied and were complicated. Acute basilar artery occlusion radiology reference article. Until the recent developments in local intraarterial or systemic intravenous fibrinolysis, interest in early diagnosis was low because there was no satisfactory treatment. If basilar artery occlusion is readily recognized and confirmed with the aid of neuroimaging, intravenous thrombolysis or endovascular treatment can be undertaken immediately in order to recanalize the occluded artery and thus reduce mortality and improve outcome. In a 73yearold man with proximal basilar artery occlusion, right carotid angiography shows fi lling of the posterior cerebral arteries, the distal basilar artery, and. Arterial reconstruction by direct surgical clipping of a basilar artery dissecting aneurysm after failed vertebral artery occlusion.
It is a true neurointerventional emergency and, if not treated early, brainstem infarction results in rapid deterioration in the level of consciousness and ultimately death. Vertebrobasilar disease is a broad classification describing the condition where there is an insufficient delivery of blood flow via the vertebral andor basilar arteries to the brain. Stroke from basilar artery disease is very variable and can range from a mild lacunar stroke, resulting from a small penetrator disease, to a large, devastating syndrome with extensive destruction of the brainstem from complete or almost complete basilar occlusion fig. Diagnosis is often delayed, or even missed, as a result of the variety of clinical presentations seen with this condition. Migraine with brainstem aura or mba formerly known as basilar migraines are headaches that start in the lower part of the brain, called the brainstem. Background performing mechanical thrombectomy mt in patients with basilar artery occlusion bao is currently not evidencebased. The basilar artery is a relatively large, robust blood vessel located in the posterior cranial fossa. Basilar artery occlusion usually causes severe disability or death. Recanalization treatments in basilar artery occlusion. Acute basilar artery occlusion bao is associated with a very poor outcome and has the highest mortality rate among intracranial largevessel occlusions 1,2. We read the results of the basilar artery international cooperation study basics registry by schoneville and colleagues1 with great interest. Pdf acute basilar artery occlusion peter zanon academia.
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