Intravenous Versus Intra-arterial Thrombolysis for Acute Ischemic Stroke Secondary to Basilar Artery Occlusion

Dual Mechanical Thrombectomy for Recanalization of a Resistant Acute Posterior Circulation Stroke

A 71-year-old man with acute basilar artery occlusion was referred for endovascular treatment 6 hours after the onset of stroke with a Glasgow Coma Score of 3 and National Institutes of Health Stroke Scale of 27. A cerebral arteriogram revealed occlusion of the left vertebral artery proximally and thromboembolic occlusion of the basilar tip. Direct aspiration and mechanical thrombectomy with various stent retrievers failed to reconstitute arterial flow in the basilar artery. Thrombolysis in cerebral infarction 2b recanalization was achieved only after placement of double Catch Mini stent retrievers through 2 microcatheters, on both side branches of the basilar bifurcation in a kissing fashion and retrieving them simultaneously. It was possible to perform this maneuver through a single distal access catheter without any complications. On follow-up the patient awakened and was able to follow commands on his right side. To our knowledge, dual mechanical thrombectomy with stent retrievers has not been reported in the posterior circulation previously. This technique may be useful in retrieving thrombi located at major intracranial bifurcations of the posterior circulation which do not recanalize with standard mechanical thrombectomy procedures. Although bilateral access to the basilar artery through both vertebral arteries is an advantage in posterior circulation for this technique, dual mechanical thrombectomy can also be performed through a unilateral access.

Outcome of acute ischemic stroke after intra-arterial thrombolysis: A study from India

Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is the currently standard treatment of acute ischemic stroke within 4.5 hours of the onset of stroke. Recent studies have looked at the benefits of administration of intra-arterial (IA) rt-PA within 8 hours onset of symptoms. Our objective was to assess the outcome of stroke after administration of IA rt-PA in patients with acute ischemic stroke. Methods: We recruited 10 consecutive acute ischemic stroke patients with onset of stroke from 4.5 hours to 6.5 hours. The present study was conducted at Yashoda Hospital, Hyderabad, India, between January 2008 and December 2013. All patients underwent stroke subtyping and were administered rt-PA. We measured the thrombolysis in cerebral infarction (TICI) score after thrombolysis and functional outcomes at time of admission, after 24 hours, 30, 60, and 90 days. A good outcome was defined as modified Rankin Scale (mRS) ≤ 2 after 90 days. Results: Out of 10 patients 9 were men, mean age 56.3 ± 1.8 years and age range from 35-68 years. On stroke subtyping, 6 (60%) patients had large artery atherosclerosis, 3 (30%) had a stroke of indeterminate etiology and 1 (10%) had a stroke of other etiologies. Mean time of recanalization was 6.2 ± 0.5 hours, 7 (70%) patients showed major neurological improvement with a mRS score of ≤ 2 at 90 days and one patient was lost to follow-up. Conclusion: Our study established good outcome at 90 days after administration of IA thrombolysis rt-PA in acute ischemic stroke.