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Cheng XY, Qiao PG, Jiang B, Zhang TT, He W. The application value of 3D ASL in evaluating the effectiveness of stent implantation for vertebrobasilar artery stenosis. Magn Reson Imaging 2024; 110:23-28. [PMID: 38552748 DOI: 10.1016/j.mri.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the effect of stent implantation for vertebrobasilar artery stenosis,by using 3D arterial spin labeling (3D ASL) technique. METHODS A retrospective analysis was conducted on the clinical and 3D ASL data of 48 patients who underwent vertebral-basilar artery stenting. Post-labeling delay times (PLD) of 1.5 s and 2.5 s were chosen, and the average regional cerebral blood flow (rCBF) values were measured in nine brain regions of the posterior circulation: bilateral thalamus, bilateral occipital lobes, bilateral cerebellar hemispheres, midbrain, pons, and medulla. The 48 patients were divided into two groups based on the presence or absence of acute ischemic stroke in the posterior cerebral circulation region detected by diffusion-weighted imaging (DWI). The preoperative and postoperative rCBF results were statistically analyzed. RESULTS In the infarct group, there were significant increases in rCBF values of all nine brain regions at both PLD = 1.5 s and 2.5 s postoperatively compared to preoperatively. At PLD = 1.5 s, statistically significant differences in rCBF values between the preoperative and postoperative periods were found in the right thalamus, left cerebellum, midbrain, and pons regions (P < 0.05). At PLD = 2.5 s, statistically significant differences in rCBF values between the preoperative and postoperative periods were observed in the left occipital lobe, right cerebellum, midbrain, and pons regions (P < 0.05). When analyzing the rCBF values of the brain regions with recent infarcts in the infarct group, there was a significant increase in postoperative rCBF values compared to preoperative values (P < 0.05). After excluding the data from brain regions with recent infarcts, the CBF values in the remaining brain regions were also increased postoperatively, and some brain regions showed statistically significant differences in rCBF values between the preoperative and postoperative periods (P < 0.05). In the non-infarct group, there were no statistically significant differences in the preoperative and postoperative rCBF values in all brain regions at both PLD = 1.5 s and 2.5 s (P > 0.05). CONCLUSION The application of 3D ASL technology shows significant value in assessing the surgical efficacy of vertebral-basilar artery stenting, especially in patients with acute posterior circulation infarction.
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Affiliation(s)
- Xiao-Yue Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Peng-Gang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Bin Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ting-Ting Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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He F, Zhong C, Wu C, Liu Y, Yu S. Relationship between serum endothelin-1 and in-stent restenosis following vertebral artery stenting. Neurol Sci 2024; 45:2711-2717. [PMID: 38157103 PMCID: PMC11081976 DOI: 10.1007/s10072-023-07276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
The study objective was to investigate the relations between serum endothelin-1 and in-stent restenosis in vertebral artery stenting. Sixty-eight patients undergoing re-examination of vertebral artery stenting in the Department of Cerebrovascular Disease, Hangzhou Third People's Hospital, between April 2019 and October 2022, were invited to participate. According to the presence of vertebral artery stenting, patients were divided into the restenosis (n = 19) or non-restenosis (n = 49) groups. General clinical data and endothelin-1 levels were compared between the groups. Logistic regression analysis was used to explore the relations between endothelin-1 level and risk for in-stent restenosis. Receiver operating characteristic curves were drawn to test the diagnostic value of serum endothelin-1 level for in-stent restenosis. Compared with the non-restenosis group, restenosis group levels of low-density lipoprotein, triglycerides, and endothelin-1 were significantly higher (p < 0.05) Multivariate logistic regression analysis showed that endothelin-1, stent length, and low-density lipoprotein were independently associated with in-stent restenosis (odds ratio = 1.502, 95% confidence interval: 0.042 ~ 0.212, p = 0.000; odds ratio = 1.899, 95% confidence interval: 1.116 ~ 2.237, p = 0.000; odds ratio = 1.899, 95% confidence interval: 1.228 ~ 3.337, p = 0.001, respectively). Area under the curve for serum endothelin-1 in the diagnosis of vertebral artery in-stent restenosis was 0.938. The best diagnostic cut-off value was 11.94 ng/L. Sensitivity was 89.5%. Specificity was 85.7%. These cumulative data indicate that endothelin-1 level is independently associated with in-stent restenosis.
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Affiliation(s)
- Fang He
- Physical Examination Center, Hangzhou Third People's Hospital, Hangzhou, China
| | - Changyang Zhong
- Cerebrovascular Disease Department, Hangzhou Third People's Hospital, Hangzhou, China.
| | - Chunli Wu
- Cerebrovascular Disease Department, Hangzhou Third People's Hospital, Hangzhou, China
| | - Yuan Liu
- Cerebrovascular Disease Department, Hangzhou Third People's Hospital, Hangzhou, China
| | - Shufeng Yu
- Department of Radiology, Zhejiang People's Hospital, Hangzhou, China
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Zitek H, Hejcl A, Sadeh M, Charbel FT, Sames M. Occipital artery to vertebral artery bypass for treatment of bilateral vertebral artery occlusion with QMRA as an adjunct to diagnostic assessment. Acta Neurochir (Wien) 2024; 166:203. [PMID: 38713241 PMCID: PMC11076335 DOI: 10.1007/s00701-024-06099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Stroke, the second leading cause of death globally, often involves ischemia in the vertebrobasilar territory. This condition is underexplored, despite significant morbidity and mortality risks. The purpose of this study is to present a case of occipital artery to V3 segment vertebral artery bypass, emphasizing the role of quantitative magnetic resonance angiography (qMRA) in assessing flow and guiding surgical intervention. METHODS A 66-year-old man with bilateral vertebral artery occlusion presented acute symptoms. qMRA was employed to evaluate flow dynamics and determine the feasibility of a flow augmentation bypass surgery. The occipital artery to left vertebral artery bypass (OA-to-VA) was performed, utilizing an inverted hockey-stick incision and an antegrade inside-out technique. The patency of the bypass was confirmed using both Doppler probe and Indocyanine green. RESULTS Postoperative assessments, including computed tomography angiography (CTA) and qMRA, demonstrated the patency of the bypass with improved flow in the basilar artery and left vertebral artery. The patient's condition remained stable postoperatively, with residual peripheral palsy of the left facial nerve. CONCLUSION In conclusion, the presented case illustrates the efficacy of the OA-to-VA bypass in addressing symptomatic bilateral vertebral artery occlusion. The study underscores the pivotal role of qMRA in pre- and postoperative assessments, providing noninvasive flow quantification for diagnostic considerations and long-term follow-up in patients with vertebrobasilar insufficiency.
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Affiliation(s)
- Hynek Zitek
- Department of Neurosurgery, Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic.
| | - Ales Hejcl
- Department of Neurosurgery, Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Morteza Sadeh
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Fady T Charbel
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Martin Sames
- Department of Neurosurgery, Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic
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McGuire LS, Charbel FT. A narrative review of techniques for surgical revascularization of the extracranial vertebral artery in vertebrobasilar insufficiency. Neurochirurgie 2024; 70:101516. [PMID: 38007180 DOI: 10.1016/j.neuchi.2023.101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Vertebrobasilar insufficiency is a condition characterized by poor blood flow through the posterior circulation of the brain, which supplies the brainstem, thalamus, hippocampus, cerebellum, occipital lobes, and medial temporal lobes. Narrowing or occlusion of the vertebral arteries may be result in a range of neurological symptoms, including dizziness, imbalance, dysarthria, and even stroke. If symptomatic patients fail medical management, revascularization of the vertebral artery should be considered. Restoration of blood flow may involve transluminal balloon angioplasty or stent placement; however, certain cases may still require surgical intervention. The complexity of surgical revascularization of the vertebral artery requires careful consideration of skull base and neck anatomy. This review article will focus on bypass of the vertebral artery in the setting of ischemic pathology, describing the technique, anatomical nuances, steps involved in preoperative planning, and postoperative management.
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Affiliation(s)
- Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
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Ndongo Sonfack DJ, Bojanowski MW, Tarabay B, Gennari A, Shédid D, Yuh SJ. Vertebral artery stenosis from osteophyte: A systematic review and case series. Neurochirurgie 2024; 70:101525. [PMID: 38277863 DOI: 10.1016/j.neuchi.2023.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Rotational vertebral artery syndrome, also referred to as Bow Hunter's syndrome (BHS), manifests when the vertebral artery (VA) is compressed following head rotation. This compression is often caused by an osteophyte and may lead to symptoms of a posterior stroke. This systematic review aims to shed light on the current management strategies for BHS resulting from osteophytes. Additionally, we present two illustrative cases where the VA compression by an osteophyte was effectively resolved by complete resection of the problematic bone spur. METHODS A literature search was conducted across Embase, PubMed and Medline in September 2023. Keywords related to vertebral artery [MESH], vertebrobasilar insufficiency [MESH] and osteophyte [MESH] were the focus of this review. Risk of bias in retained studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for Qualitative Research. A narrative synthesis of our findings is presented. RESULTS A total of 30 studies were included in this review. Vertigo was the most reported symptom by patients (n = 16). On imaging, the VA was often compressed at C4-5 (n = 10) and C5-6 (n = 10) with no evident side predominance observed. Anterior cervical discectomy and fusion (ACDF, n = 13) followed by anterior decompression without fusion (n = 8) were the most performed surgical procedures to manage BHS. CONCLUSION Surgical decompression of the VA is a safe and effective intervention for patients experiencing symptomatic osteophytic compression during head rotation. This procedure restores normal vascular function and reduces the risk of ischemic events. This review highlights the importance of timely diagnosis and intervention in such cases.
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Affiliation(s)
| | | | - Bilal Tarabay
- Department of Neurosurgery, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - Antoine Gennari
- Division of Spine Surgery, Center Hospital of the University of Nice, Alpes-Maritimes, France
| | - Daniel Shédid
- Department of Neurosurgery, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - Sung-Joo Yuh
- Department of Neurosurgery, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
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Yan Y, Zhang K, Zhong W, Yan S, Zhang B, Cheng J, Lou M. Influencing factors of futile recanalization after endovascular intervention in patients with acute basilar artery occlusion. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:141-150. [PMID: 38501295 PMCID: PMC11057989 DOI: 10.3724/zdxbyxb-2023-0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/21/2023] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To explore the influence factors for futile recanalization following endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO). METHODS Clinical data of patients with acute BAO, who underwent endovascular treatment within 24 h of onset from January 2017 to November 2022, were retrospectively analyzed. The futile recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) grade ≥2b or 3 after successful reperfusion, but the modified Rankin Scale score >2 at 3 months after EVT. Binary logistic regression model was used to analyze the influencing factors of futile recanalization. RESULTS A total of 471 patients with a median age of 68 (57, 74) years were included and 68.9% were males, among whom 298 (63.27%) experienced futile recanalization. Multivariate analysis revealed that concomitant atrial fibrillation (OR=0.456, 95%CI: 0.282-0.737, P<0.01), bridging thrombolysis (OR=0.640, 95%CI: 0.416-0.985, P<0.05), achieving mTICI grade 3 (OR=0.554, 95%CI: 0.334-0.918, P<0.05), arterial occlusive lesion (AOL) grade 3 (OR=0.521, 95%CI: 0.326-0.834, P<0.01), and early postoperative statin therapy (OR=0.509, 95%CI: 0.273-0.948, P<0.05) were protective factors for futile recanalization after EVT in acute BAO patients. High baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=1.068, 95%CI: 1.049-1.087, P<0.01), coexisting hypertension (OR=1.571, 95%CI: 1.017-2.427, P<0.05), multiple retrieval attempts (OR=1.237, 95%CI: 1.029-1.488, P<0.05) and postoperative hemorrhagic transformation (OR=8.497, 95%CI: 2.879-25.076, P<0.01) were risk factors. For trial of ORG 10172 in acute stroke treatment (TOAST) classification, cardiogenic embolism (OR=0.321, 95%CI: 0.193-0.534, P<0.01) and other types (OR=0.499, 95%CI: 0.260-0.961, P<0.05) were related to lower incidence of futile recanalization. CONCLUSIONS The incidence of futile recanalization after EVT in patients with acute BAO is high. Bridging venous thrombolysis before operation and an early postoperative statin therapy may reduce the incidence of futile recanalization.
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Affiliation(s)
- Yi Yan
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
- Department of Neurology, Zhenhai People's Hospital, Ningbo 315202, Zhejiang Province, China.
| | - Kemeng Zhang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Bing Zhang
- Department of Neurology, Huzhou Central Hospital, Huzhou 313099, Zhejiang Province, China
| | - Jianhua Cheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, Zhejiang Province, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Shurkhay V, King BL, Acuff NJ, Neel J, Kalani MYS. Transcervical Vertebral Artery Origin Endarterectomy for Vertebrobasilar Insufficiency. World Neurosurg 2024; 184:14. [PMID: 38185454 DOI: 10.1016/j.wneu.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024]
Abstract
Vertebral artery (VA) stenosis is a cause of vertebrobasilar insufficiency (VBI) and disabling posterior circulation stroke,1 accounting for up to 30% of all strokes.2 Although the natural history of VBI is not as well delineated as that of carotid stenosis, strokes in the basilar circulation can be more disabling than their anterior circulation counterparts. Stenosis exceeding 30% at the origin of the vertebral artery is associated with increased risk of stroke.3 The authors present a case of a female patient with significant peripheral vascular disease who presented with concerns for VBI. The patient was on antiplatelet and anticoagulative medications and a statin at the time of her presentation. Angiography demonstrated bilateral vertebral artery origin stenosis. The left VA was diminutive and arose directly from the arch (Video 1). The right VA demonstrated critical stenosis at its origin. Attempts at endovascular access of the right VA for placement of a balloon-mounted stent were unsuccessful. The patient underwent a transcervical approach for endarterectomy of the VA origin. The VA can be readily accessed using a small supraclavicular incision to isolate the V1 segment of the vessel. The procedure was performed with the patient heparinized and on antiplatelet medications. Alternatives to this strategy include patch grafting in addition to the endarterectomy or use of a short vein graft to bypass the stenosis of the VA beyond the stenotic segment.
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Affiliation(s)
- Vsevolod Shurkhay
- Department of Neurological Surgery, St. John's Neuroscience Institute, Tulsa, Oklahoma, USA
| | - Brandon L King
- Department of Neurological Surgery, St. John's Neuroscience Institute, Tulsa, Oklahoma, USA
| | - Nikki J Acuff
- Department of Neurological Surgery, St. John's Neuroscience Institute, Tulsa, Oklahoma, USA
| | - James Neel
- Department of Cardiothoracic Surgery, Ascension St. John's Medical Center, Tulsa, Oklahoma, USA
| | - M Yashar S Kalani
- Department of Neurological Surgery, St. John's Neuroscience Institute, Tulsa, Oklahoma, USA.
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Eley N, Kumar R, Ryan R, Sethi R. Vertebrobasilar Insufficiency Syndrome in Extension: Insights into Surgical Treatment. World Neurosurg 2024; 183:71-75. [PMID: 38092356 DOI: 10.1016/j.wneu.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Rotational vertebrobasilar artery syndrome, or bow hunter syndrome, is a rare yet well-documented pathology. This study presents a surgical approach to a latent manifestation of dynamic, extension-only, bilateral codominant vertebral artery compression in the V3 segment, associated with craniocervical instability and central canal stenosis. METHODS The clinical presentation involves the treatment of positional vertigo resulting from left and high-grade right vertebral artery stenosis during neck extension only. Diagnosis was confirmed through a formal angiogram under provocative maneuvers. Surgical intervention, detailed in this section, employed a multidisciplinary approach, including intraoperative angiograms to ensure patent vertebral arteries precraniocervical fusion. RESULTS The surgical treatment demonstrated success in addressing extension-only vertebrobasilar syndrome and associated complications of C1-2 pannus and craniocervical instability. Intraoperative angiograms confirmed vertebral artery patency pre- and postsurgical positioning, ensuring the effectiveness of the multidisciplinary approach. CONCLUSIONS This study concludes by highlighting the successful multidisciplinary surgical treatment of a patient with nonunion of a C1 Jefferson fracture, leading to extension-only vertebrobasilar syndrome complicated by C1-2 pannus and craniocervical instability. The importance of considering vertebral artery dynamic stenosis in cases of positional vertigo or transient neurological symptoms following an injury is emphasized. Surgical stabilization, particularly when conservative measures prove ineffective, is recommended, with careful attention to pre- and postsurgical positioning to verify vertebral artery patency and posterior vasculature integrity.
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Affiliation(s)
- Nicholas Eley
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rakesh Kumar
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Robert Ryan
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rajiv Sethi
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA.
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Ji Z, He C, Li J, Geng J, Hu P, Li G, Zhang H. Safety and Efficacy of Low-Profile Braided Stents versus Flow Diverters in the Reconstructive Technique in the Treatment of Patients with Vertebrobasilar Dolichoectasia Aneurysms: A Cohort of 47 Patients with Long-Term Follow-Up. AJNR Am J Neuroradiol 2024; 45:176-182. [PMID: 38238095 DOI: 10.3174/ajnr.a8091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND PURPOSE Vertebrobasilar dolichoectasia aneurysm is a rare type of cerebrovascular disorder with a poor natural history, and endovascular treatment is widely accepted. Whether a high-profile braided stent (flow diverter) could promote occlusion of vertebrobasilar dolichoectasia aneurysm without increasing the complications rather than a low-profile braided stent remains uncertain. The aim of the study was to present a single-center experience of the safety and efficacy of a low-profile braided stent versus a flow diverter in treating patients with vertebrobasilar dolichoectasia aneurysms. MATERIALS AND METHODS The retrospective review was conducted on a total of 432 consecutive patients diagnosed with posterior circulation aneurysms who underwent endovascular treatment in our center from August 2013 to December 2021. Among these patients, 47 individuals with vertebrobasilar dolichoectasia aneurysms who were treated with low-profile braided stents or flow diverters were included. Vertebrobasilar dolichoectasia aneurysms involving only the vertebral artery were excluded. Patients were divided into 2 groups: the low-profile braided stent group and the flow diverter group based on the device used. Safety and efficacy outcomes were subsequently analyzed. RESULTS There were 25 total patients enrolled in low-profile braided stent group and 22 patients in flow diverter group. The safety of low-profile braided stents and flow diverters in the treatment of vertebrobasilar dolichoectasia aneurysms was evaluated by clinical outcome, a new neurologic deficit due to procedural complications, and neurologic death. The rates of good clinical outcome were similar between the 2 groups (low-profile braided stent, 56%, versus flow diverter, 59.1%; P = .831), and the rates of neurologic death were also similar (low-profile braided stent, 12%, versus flow diverter, 9.1%; P = .747). Higher rates of new neurologic deficits due to procedural complications were observed in the flow diverter group, but the difference was not significant (low-profile braided stent, 24%, versus flow diverter, 40.9%; P = .215). The efficacy was evaluated by angiographic occlusion of vertebrobasilar dolichoectasia aneurysms and progression of mass effect resulting from these aneurysms. Significantly higher rates of complete occlusion of vertebrobasilar dolichoectasia aneurysms were shown in the flow diverter group (41.2%; P = .028) than in the low-profile braided stent group (10%). CONCLUSIONS Both low-profile braided stents and flow diverters have similar high risks in reconstructive techniques in the treatment of vertebrobasilar dolichoectasia aneurysms, while a flow diverter is more effective in promoting complete occlusion of vertebrobasilar dolichoectasia aneurysm than a low-profile braided stent. A flow diverter may be a better alternative for carefully selected patients with vertebrobasilar dolichoectasia aneurysms.
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Affiliation(s)
- Zhe Ji
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Chuan He
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Jingwei Li
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Jiewen Geng
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Peng Hu
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Guilin Li
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Hongqi Zhang
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
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Algattas H, Mitha R, Agarwal N, Lang MJ. Bow Hunter Syndrome: An Illustrative Case and Operative Management. World Neurosurg 2024; 182:135. [PMID: 37797682 DOI: 10.1016/j.wneu.2023.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
The differential for vertebrobasilar insufficiency is wide and can be caused by posterior circulation infarcts, steal-type phenomena, or other systemic causes. In the absence of imaging findings explaining symptomology, the utility of appropriate history gathering and dynamic angiography cannot be understated in identifying Bow Hunter's syndrome, a rare cause of dynamic vertebrobasilar insufficiency. We present a case of a 69-year-old man who complained of presyncope and severe dizziness when turning his head towards the right. On examination he had no radiculopathy but did have objective evidence of myelopathy. Computed tomography imaging and dynamic angiography demonstrated C3-C4 right uncovertebral joint hypertrophy and near complete stenosis of the right vertebral artery with dynamic head position towards the right. Given vertebrobasilar insufficiency and myelopathy, he was taken to the operating room for C3-C4 anterior cervical discectomy and fusion with vertebral artery decompression (Video 1). The patient provided consent for the procedure. Standard anterior cervical neck dissection was undertaken with additional platysmal undermining to facilitate exposure of the right uncovertebral joint and transverse processes. The vertebral artery was first decompressed above and below the area of most significant stenosis at the respective transverse foramina before the hypertrophied uncovertebral joint was removed. Next, discectomy and posterior osteophyte removal were completed in typical fashion followed by graft, plate, and screw placement. Postoperatively the patient had immediate resolution of symptoms and continued so at eight month follow-up. Imaging demonstrated return to normal caliber of the right vertebral artery and successful decompression.
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Affiliation(s)
- Hanna Algattas
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Takano Y, Koyanagi M, Takamatsu T, Tokuda M, Tomita H, Yoshimoto M, Sakisuka R, Kawade S, Naramoto Y, Nishii R, Yamamoto Y, Nakajima K, Teranishi K, Fukui N, Sunohara T, Fukumitsu R, Takeda J, Ohara N, Goto M, Imamura H, Sakai N, Ohta T. Clinical evaluation of mechanical thrombectomy for patients with posterior circulation occlusion: A retrospective study. Clin Neurol Neurosurg 2024; 237:108133. [PMID: 38340428 DOI: 10.1016/j.clineuro.2024.108133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Although consensus has been reached regarding the use of mechanical thrombectomy for acute large anterior circulation occlusion, its effectiveness in patients with posterior circulation occlusion remains unclear. This study aimed to establish the determining factors for good clinical outcomes of mechanical thrombectomy for posterior circulation occlusion. METHODS We extracted cases of acute large vessel occlusion (LVO) in the posterior circulation from a database comprising 536 patients who underwent mechanical thrombectomy at our hospital between April 2015 and March 2021. RESULTS Fifty-two patients who underwent mechanical thrombectomy for LVO in the posterior circulation were identified. Five patients with simultaneous occlusion of the anterior and posterior circulation were excluded; finally, 47 patients were included in this study. The median patient age was 78 years, and 36% of the patients were women. The median National Institutes of Health Stroke Scale (NIHSS) score on admission was 31, the median posterior circulation-Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS) was 8, and the median Basilar Artery on Computed Tomography Angiography (BATMAN) score was 6. The rate of good recanalization (Thrombolysis in Cerebral Infarction scale grades 2b and 3) was 96%, and a good prognosis (modified Rankin Scale score of 0-2 at 90 days) was achieved in 19 patients (40%). The median pc-ASPECTS was significantly higher in the good prognosis group than in the poor prognosis group (10 vs. 7; p = 0.007). The median NIHSS score at presentation was significantly lower in the good prognosis group than in the poor prognosis group (17 vs. 34; p = 0.02). The median BATMAN score was significantly higher in the good prognosis group than in the poor prognosis group (8 vs. 3.5; p = 0.0002). Multivariate analysis showed that an NIHSS score ≦ 20 at presentation was the only independent factor for good prognoses. CONCLUSION The prognosis of mechanical thrombectomy for posterior circulation LVO was better in patients with lower NIHSS scores at presentation.
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Affiliation(s)
- Yuki Takano
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaomi Koyanagi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Takateru Takamatsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masanori Tokuda
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hikari Tomita
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mai Yoshimoto
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryo Sakisuka
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satohiro Kawade
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuji Naramoto
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Rikuo Nishii
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Yamamoto
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kota Nakajima
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kunimasa Teranishi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Fukui
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadashi Sunohara
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryu Fukumitsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Junichi Takeda
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masanori Goto
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Miyamoto S, Hayakawa M, Okune S, Shintoku R, Yamano A, Hiramine T, Takahashi T, Hosoo H, Ito Y, Marushima A, Koda M, Ishikawa E, Matsumaru Y. Hidden Bow Hunter's Syndrome Diagnosed Using Dynamic Cerebral Angiography and Successfully Treated with Spinal Surgery: A Case Report and Review of the Literature. Intern Med 2024; 63:327-331. [PMID: 37286508 PMCID: PMC10864088 DOI: 10.2169/internalmedicine.1386-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/25/2023] [Indexed: 06/09/2023] Open
Abstract
Hidden bow hunter's syndrome (HBHS) is a rare disease in which the vertebral artery (VA) occludes in a neutral position but recanalizes in a particular neck position. We herein report an HBHS case and assess its characteristics through a literature review. A 69-year-old man had repeated posterior-circulation infarcts with right VA occlusion. Cerebral angiography showed that the right VA was recanalized only with neck tilt. Decompression of the VA successfully prevented stroke recurrence. HBHS should be considered in patients with posterior circulation infarction with an occluded VA at its lower vertebral level. Diagnosing this syndrome correctly is important for preventing stroke recurrence.
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Affiliation(s)
- Satoshi Miyamoto
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
| | - Sho Okune
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
| | - Ryosuke Shintoku
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Akinari Yamano
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Takato Hiramine
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
| | - Toshihide Takahashi
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hisayuki Hosoo
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiro Ito
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Aiki Marushima
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
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13
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Shang X, Pan L, Xu Y, Guo Y, Yang K, Yang Q, Zhou Z. Effect of endovascular treatment on patients with basilar artery occlusion presenting with different pathologic mechanisms: a systematic review and meta-analysis. J Thromb Thrombolysis 2024; 57:124-131. [PMID: 37605064 DOI: 10.1007/s11239-023-02884-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms. METHODS Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms. RESULTS A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms. CONCLUSION Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.
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Affiliation(s)
- Xianjin Shang
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China.
| | - Liying Pan
- Department of Neurology, Longyan First Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Youqing Xu
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Yapeng Guo
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Ke Yang
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui Province, China
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14
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Baek BH, Lee YY, Kim SK, Yoon W. Superior cerebellar artery occlusion remaining after thrombectomy for acute basilar artery occlusion. Sci Rep 2023; 13:22395. [PMID: 38104225 PMCID: PMC10725465 DOI: 10.1038/s41598-023-50023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
To investigate the incidence and impact of superior cerebellar artery (SCA) occlusion remaining after thrombectomy for acute basilar artery occlusion (BAO). We retrospectively analyzed data from 116 patients who underwent thrombectomy for BAO. The patency of SCA was assessed on final angiograms. Clinical and radiologic data of the patients were retrieved from a prospectively collected database and analyzed. All patients underwent pretreatment and follow-up DWI to detect new infarctions in SCA territory. Ten patients (8.6%) had SCA occlusions on final angiograms. Of these, two patients had bilateral occlusions. A new infarction with a diameter ranged from 4 to 11 mm in corresponding SCA territory occurred in 5 of 10 patients. No patients with SCA occlusions experienced symptomatic cerebellar hemorrhage or malignant cerebellar infarction. Nine of 12 SCA occlusions showed spontaneous recanalization on follow-up CT angiography. Four of 10 patients showed 90-day favorable outcome (mRS 0-3) and 90-day mortality occurred in one patient. SCA occlusions remaining after thrombectomy for acute BAO had a benign clinical course. Most of these lesions recanalized spontaneously. Our study suggests that attempts to recanalize remnant SCA occlusion may be unnecessary after basilar artery thrombectomy.
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Affiliation(s)
- Byung Hyun Baek
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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15
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Sun D, Huo X, Raynald, Mo D, Gao F, Ma N, Albers GW, Miao Z. Outcome prediction value of critical area perfusion score for acute basilar artery occlusion. Interv Neuroradiol 2023; 29:702-709. [PMID: 36112757 PMCID: PMC10680966 DOI: 10.1177/15910199221125853] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To investigate the performance of the Critical Area Perfusion Score (CAPS), based on computed tomography perfusion (CTP) time to maximum (Tmax) > 10s maps, to predict the outcome in acute basilar artery occlusion (BAO) in patients undergoing endovascular treatment (EVT). METHODS We perform a retrospective analysis of a prospectively collected database of acute BAO treated with EVT in a comprehensive stroke center. The favorable outcome was defined as the 90-day modified Rankin Scale (mRS) ≤ 3. We performed the logistic regression analysis to find the independent predictors of the favorable outcome. Then, we used receiver operating characteristic analyses to assess the predictive value of the imaging parameters, including CAPS, Posterior Circulation Alberta Stroke Program Early CT Score (PC-ASPECTS), pons midbrain index (PMI), posterior circulation computed tomography angiography (PC-CTA) score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, and CTP parameters. Finally, the Delong test was used to compare the area under the curve (AUC) of CAPS against the other imaging parameters. RESULTS Of the 65 enrolled patients, the incidence of the favorable outcome was 44.6% (29/65). Low CAPS (per 1- point increased odds ratio [OR], 0.43; 95% confidence interval [CI], 0.22-0.86; P = 0.017) and admission National Institutes of Health Stroke Scale (NIHSS) (per 1- point increased OR, 0.80; 95% CI, 0.70-0.91; P = 0.001) were independently associated with favorable outcome. The AUC of CAPS was 0.83 (95% CI, 0.74-0.93; P < 0.001) with ≤ 3 cut-off value, 89.66% sensitivity, 77.22% specificity, and 80.00% accuracy, which was greater than the other imaging parameters (All P for Delong test < 0.05). CONCLUSIONS CAPS was the most accurate imaging-based outcome predictor in acute BAO patients. Future large prospective multicenter studies are needed to verify these results.
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Affiliation(s)
- Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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16
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Takeshima Y, Motoyama Y, Nakagawa I, Eura N, Saito K, Sugie K, Nakase H. Embolic stroke induced by rotational persistent 1st intersegmental artery compression. Br J Neurosurg 2023; 37:1835-1838. [PMID: 34180319 DOI: 10.1080/02688697.2021.1940854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
A 45-year-old man suffered multiple cerebral infarctions in the vertebrobasilar artery territory, followed by second stroke against conservative treatment. Radiological examinations revealed intra-arterial defect in left persistent 1st intersegmental artery (PFIA) at C1 level, suggesting mural thrombus, and mechanical compression of left PFIA at the level with head rotation to the right clearly revealed by reconstructed 3-dimensional radiological images, but no findings of atlantoaxial instability. One month after the second stroke, posterior fixation was performed. Postoperative course was uneventful without subsequent stroke for 24 months. This unique case demonstrated that PFIA might associate with cerebral stroke as a clinical condition of bow hunter's stroke even in middle age. Reconstructed 3-dimensional radiological images might be useful for clear demonstration of the pathophysiology in this complex clinical entity.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nobuyuki Eura
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kozue Saito
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kazuma Sugie
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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17
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Pan X, Lin S, Xiang L, Zhou F, Xu M, Jie Q, Zhao Z, Chen C, Zhou J, Zou J. Dynamic and visual nomograms to online predict unfavorable outcome of mechanical thrombectomy for acute basilar artery occlusion. Brain Behav 2023; 13:e3297. [PMID: 37957826 PMCID: PMC10726912 DOI: 10.1002/brb3.3297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The evidence of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) was limited. This study aimed to develop dynamic and visual nomogram models to predict the unfavorable outcome of MT in BAO online. METHODS BAO patients treated with MT were screened. Preoperative and postoperative nomogram models were developed based on clinical parameters and imaging features. An independent dataset was collected to perform external validation. Web-based calculators were constructed to provide convenient access. RESULTS A total of 127 patients were included in the study, and 117 of them were eventually included in the analysis. The nomogram models showed robust discrimination, with an area under the receiver operating characteristic (ROC) of 0.841 (preoperative) and 0.916 (postoperative). The calibration curves showed good agreement. The preoperative predictors of an unfavorable outcome were previous stroke, the National Institutes of Health Stroke Scale (NIHSS) at admission, and the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS). The postoperative predictors were previous stroke, NIHSS at 24 h, and pc-ASPECTS. CONCLUSION Dynamic and visual nomograms were constructed and validated for the first time for BAO patients treated with MT, which provided precise predictions for the risk of an unfavorable outcome. The preoperative model may assist clinicians in selecting eligible patients, and the postoperative model may facilitate individualized poststroke management.
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Affiliation(s)
- Xiding Pan
- Department of PharmacyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
- Department of NeurologyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
- School of Basic Medicine and Clinical PharmacyChina Pharmaceutical UniversityNanjingP. R. China
| | - Shiteng Lin
- Department of Pharmacy, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenP. R. China
| | - Liang Xiang
- Department of NeurologyThe First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal UniversityChangshaP. R. China
| | - Feng Zhou
- Department of NeurologyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
| | - Mengyi Xu
- Department of NeurologyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
| | - Qiong Jie
- Department of PharmacyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
| | - Zhihong Zhao
- Department of NeurologyThe First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal UniversityChangshaP. R. China
| | - Chen Chen
- Department of PharmacyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
| | - Junshan Zhou
- Department of NeurologyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
| | - Jianjun Zou
- Department of PharmacyNanjing First Hospital, Nanjing Medical UniversityNanjingP. R. China
- School of Basic Medicine and Clinical PharmacyChina Pharmaceutical UniversityNanjingP. R. China
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18
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Tian T, Li Z, Yu M, Xie Y, Sun W, Du J, Yin S. Effect of stroke etiology on endovascular treatment in patients with acute basilar artery occlusion. Minerva Surg 2023; 78:719-721. [PMID: 34889572 DOI: 10.23736/s2724-5691.21.09299-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tian Tian
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurological Surgery, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Zhongzhen Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin Neurosurgical Institute, Tianjin, China
| | - Miao Yu
- Department of Neurological Surgery, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Yunpeng Xie
- Department of Neurological Surgery, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Wenhao Sun
- Department of Neurological Surgery, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Jia Du
- Department of Neurological Surgery, Cangzhou Center Hospital, Cangzhou, China
| | - Shaoya Yin
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China -
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin Neurosurgical Institute, Tianjin, China
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19
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Yuan X, Zhao H, Shan Y, Huang J, Hu J, Yang J, Peng Z, Kong W, Guo C, Zi W, Yu N. Effect of collateral status on the outcomes of endovascular treatment of acute basilar artery occlusion due to large-artery atherosclerosis. J Neurosurg 2023; 139:1715-1721. [PMID: 37310068 DOI: 10.3171/2023.4.jns222779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/21/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Authors of this study aimed to evaluate the effects of collateral status on the prognostic value of endovascular treatment (EVT) in patients with basilar artery occlusion (BAO) due to large-artery atherosclerosis (LAA). METHODS The study included 312 patients from the BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry who had undergone EVT for acute BAO due to LAA and whose composite collateral scores were available. The effects of collateral status on EVT were assessed based on the composite collateral score (0-2 vs 3-5). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. RESULTS The composite collateral score was 0-2 in 130 patients and 3-5 in 182. A good collateral status (composite collateral score 3-5) was associated with a favorable outcome (66/182 [36.3%] vs 31/130 [23.8%], adjusted odds ratio [aOR] 2.21, 95% CI 1.18-4.14, p = 0.014). A lower baseline National Institutes of Health Stroke Scale (NIHSS) score was an independent predictor of a favorable outcome in the poor collateral status group (aOR 0.91, 95% CI 0.87-0.96, p = 0.001). In the good collateral status group, there was a significant correlation between favorable outcomes and a younger age (aOR 0.96, 95% CI 0.92-0.99, p = 0.016), lower baseline NIHSS score (aOR 0.89, 95% CI 0.85-0.93, p < 0.001), lower proportion of diabetes mellitus (aOR 0.31, 95% CI 0.13-0.75, p = 0.009), and shorter procedure time (aOR 0.99, 95% CI 0.98-1.00, p = 0.003). CONCLUSIONS A good collateral status was a strong prognostic factor after EVT in patients with BAO underlying LAA. A shorter procedure time was associated with favorable outcomes in patients with a good collateral status.
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Affiliation(s)
- Xingyun Yuan
- 1Department of Neurology, The First People's Hospital of Xianyang City, Xianyang, Shanxi
| | - Haojin Zhao
- 2Department of Neurology, Luoyang Mengjin Second People's Hospital, Luoyang, Henan
| | - Yuanjun Shan
- 3Department of Neurology, Xiangzhou District People's Hospital, Xiangyang, Hubei; and
| | - Jiacheng Huang
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinrong Hu
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhouzhou Peng
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Weilin Kong
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Changwei Guo
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Nizhen Yu
- 4Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
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Sato M, Yamahata H, Yasuda M, Hiwatari T, Yonenaga M, Ishimaru K, Miyanohara O, Shimozuru T, Yoshimoto K. Treatment of rotational/positional vertebral artery occlusion due to degenerative changes in the cervical vertebrae: A case report and review of the literature. J Orthop Sci 2023; 28:1614-1619. [PMID: 35078705 DOI: 10.1016/j.jos.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/21/2021] [Accepted: 12/23/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Masanori Sato
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan.
| | - Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Muneyoshi Yasuda
- Division of Neurosurgery, Ichinomiyanishi Hospital, Ichinomiya,1 Kaimeihira, Ichinomiya-shi, Aichi, 494-0001, Japan
| | - Takaaki Hiwatari
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Masanori Yonenaga
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Koichi Ishimaru
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Osamu Miyanohara
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Tetsuro Shimozuru
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
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21
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Zhang Y, Hu Y, Gu X, Leng S, Tang D, Sun J, Ding J. Long-Term Outcomes After Stenting in Extracranial vs. Intracranial Stenosis. Altern Ther Health Med 2023; 29:255-261. [PMID: 37573598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Objective The purpose of this pilot study is to explore the difference in safety and effectiveness after stenting in patients with extracranial or intracranial vertebral artery stenosis. Methods The study involved 26 patients treated with stents for ≥70% stenosis between January 1, 2017, and September 8, 2020. The patients were divided into intracranial and extracranial groups based on the location of the target vessel stenosis. The incidence of stroke or death within 30 days, long-term recurrence of ischemic symptoms, and restenosis during follow-up were monitored. Results Within 30 days, no stroke or death was observed in the 26 patients, During the follow-up period, the risk of recurrence of posterior circulation stroke or transient ischemic attack was 23.1% (6/26). Vascular-related complications were 5.6% vs. 12.5% (P = .529) in the intracranial vs. extracranial stenosis group. After 1 year, stroke or transient ischemic attack of posterior circulation was observed in 12.5% (1/8) vs. 16.7% (3/18) in the intracranial and extracranial stenosis group, respectively. The restenosis rate in the intracranial stenosis group was higher than the extracranial stenosis group (37.5% vs. 28.6%, P > .05). This trend was also found in the asymptomatic restenosis rate (25% vs. 7.1%, P = .527). Conclusions The study results showed that there was no significant difference in the safety and effectiveness after stenting in extracranial and intracranial vertebral artery stenosis, but intracranial vertebral artery stenosis has a low rate of symptomatic restenosis. Symptomatic restenosis may be an important problem that limits the efficacy of extracranial vertebral artery stenting.
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Huang R, Gao F, Mo D, Yang M, Hou Z, Liu Y, Cui R, Kang K, Gu W, Miao Z, Ma N. High-Resolution Magnetic Resonance Imaging in Endovascular Treatment of Vertebrobasilar Junction Stenosis. Neurologist 2023; 28:413-418. [PMID: 37027180 PMCID: PMC10627536 DOI: 10.1097/nrl.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Vertebrobasilar junction (VBJ) stenosis is a challenge in endovascular treatment due to structural variants and complexities. The role of high-resolution magnetic resonance imaging (HRMRI) in endovascular treatment for patients with severe VBJ stenosis is uncertain. CASE REPORT Four patients with symptomatic VBJ stenosis underwent HRMRI of the vessel wall before endovascular treatment. In 3 patients, the VBJ could not be visualized on luminal imaging. One of them had a hypoplastic artery and 2 of them had severe stenotic arteries on HRMRI. HRMRI showed an artery with a negative remodeling in a patient with a hypoplastic vertebral artery. One patient had intraplaque hemorrhage and calcification, and 2 patients had calcification in VBJ lesions. Endovascular treatment was performed utilizing HRMRI findings to guide the decision-making process. CONCLUSION HRMRI provides additional information about the structure and angle of the VBJ, the characteristics and vulnerability of the plaques, and the lesion size, thus helping to improve the operation process and reduce the risk of complications.
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Affiliation(s)
- Rui Huang
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
| | - Feng Gao
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Dapeng Mo
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Ming Yang
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Zhikai Hou
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Yifan Liu
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Rongrong Cui
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Kaijiang Kang
- Department of Neurology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Weibin Gu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Zhongrong Miao
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Ning Ma
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
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23
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Cao X, Chen X, Qu B, Wang Z, Fan D, Li S. Endovascular Stent Implantation in the Treatment of Vertebrobasilar Dolichoectasia. J Craniofac Surg 2023; 34:e632-e636. [PMID: 37336470 DOI: 10.1097/scs.0000000000009437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/15/2023] [Indexed: 06/21/2023] Open
Abstract
Vertebrobasilar dolichoectasia (VBD) is a rare disease in clinic, with an incidence of 0.06% and 5.8%. It is a progressive vascular disease caused by the dilatation, tortuosity, and prolongation of vertebral and basilar arteries caused by a variety of factors. VBD can lead to hemodynamic changes, ischemic stroke, compression symptoms due to vasodilation, neurological dysfunction, hydrocephalus, subarachnoid hemorrhage, and other clinical manifestations. However, because the condition of VBD is complex and changeable, the treatment of VBD is not uniform. With the development of vascular intervention, especially the development of stent technology, it may become an effective method for the treatment of VBD. Two patients with VBD were treated with endovascular stent implantation.
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Affiliation(s)
- Xuemin Cao
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Xiaoshuai Chen
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Bingkun Qu
- Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Zengwu Wang
- Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Danjie Fan
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Sen Li
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
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24
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Bai B, Huang S, Ning C, Wang Y, Lei W, Xi X, Zhang H, Liu T, Gao Y, Shi H, He H, Cui J, Li Y. Predictive Value of a Novel Baseline Diffusion-Weighted Imaging Posterior Circulation Score in Endovascular Treatment of Patients with Acute Vertebrobasilar Occlusion. Acad Radiol 2023; 30:2212-2221. [PMID: 37453882 DOI: 10.1016/j.acra.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023]
Abstract
RATIONALE AND OBJECTIVES 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). MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION Our novel-PC score, based on DWI, can independently predict functional prognosis in patients with acute VBAO after EVT. CLINICAL RELEVANCE 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.
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Affiliation(s)
- Bofeng Bai
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Shanshan Huang
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Cong Ning
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Yannan Wang
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Wei Lei
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Xiaoyi Xi
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Haoyu Zhang
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Ting Liu
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Yifei Gao
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Hong Shi
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Hong He
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.)
| | - Jian Cui
- Department of Neurosurgery, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (J.C.)
| | - Yongbin Li
- Department of Radiology, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, China (B.B., S.H., C.N., Y.W., W.L., X.X., H.Z., T.L., Y.G., H.S., H.H., Y.L.).
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25
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Zheng W, Wang L, Wang H, Zhou H, Du Q. Trigeminal neuralgia caused by vertebrobasilar dolichoectasia: efficacy of stepwise decompression technique. Acta Neurochir (Wien) 2023; 165:3019-3026. [PMID: 37353618 DOI: 10.1007/s00701-023-05691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To explore and analyze the clinical efficacy of a stepwise decompression technique in the treatment of trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD). METHODS A total of 918 patients with TN admitted to our hospital from June 2015 to May 2020 were divided into the VBD group (n = 61) and the conventional group (n = 857). The VBD group underwent stepwise decompression, while the conventional group received traditional microvascular decompression (MVD) surgery. Patients associated with the VBD were divided into direct compression (n = 14) and indirect compression group (n = 47) who had compression by other vessels in the presence of the VBD. Thereafter, the clinical data, intraoperative findings, efficacy, and complications were analyzed. RESULTS The curative ratio, efficacy, and recurrence rate for the VBD and conventional group were 83.6% and 89.6%, 93.4% and 95.3%, and 8.2% and 5.3%, respectively. The curative ratio, efficacy, and recurrence rate for the direct compression and indirect compression group were 85.7% and 83.0%, 92.9% and 93.6%, and 7.1% and 8.5%, separately. There were no significant differences in the curative ratio, efficacy, recurrence rate, and the incidence of complications between the two series (P > 0.05). CONCLUSION For TN caused by VBD, stepwise decompression not only reduces the direct compression of the trigeminal nerve by VBA but also allows identification and decompression of the actual vessels responsible for the compression. It has a good curative ratio, efficacy, and long-term pain relief rate, and it does not significantly increase the incidences of complications after surgery.
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Affiliation(s)
- Wenhao Zheng
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linjie Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Heng Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haotian Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Quan Du
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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26
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Li AH, Guo J, Liu HM, Liu XQ. Intravascular ultrasound guided vertebral artery stenting after basilar artery thrombectomy for acute brain stem stroke. J Clin Ultrasound 2023; 51:1261-1263. [PMID: 37318281 DOI: 10.1002/jcu.23506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
A 64-year-old lady presented as right vertebral artery occlusion and brain stem stroke (Figure 1A). Emergent thrombectomy opened the artery, but it re-occluded 10 minutes later (Figure 1B,C). Intravascular ultrasound showed heavy plaque burden and guided a balloon-expandable stenting successfully (Figure 1D-F).
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Affiliation(s)
- Ai-Hsien Li
- Far East Cardiocerebrovascular Hospital, Harbin, China
- Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Jinjian Guo
- Far East Cardiocerebrovascular Hospital, Harbin, China
| | - Hon-Man Liu
- National Taiwan University Hospital, Taipei, Taiwan
- Fu-Jen University Hospital, New Taipei, Taiwan
| | - Xiao Qian Liu
- Far East Cardiocerebrovascular Hospital, Harbin, China
- The second hospital of Heilongjiang province, Harbin, China
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Yang K, Fang S, Zhang X, Wang T, Feng Y, Jiao L, Yan Y. In-stent restenosis after vertebral artery origin stenosis stenting: a nomogram for risk assessment. J Neurointerv Surg 2023; 15:e41-e45. [PMID: 35896318 DOI: 10.1136/neurintsurg-2022-019091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To propose a nomogram for individual risk assessment of in-stent restenosis (ISR) after vertebral artery origin stenosis (VAOS) stenting. METHODS We included 793 patients with VAOS treated with stenting from October 2006 to May 2013, with a median follow-up of 27.8 months. Cox regression and the least absolute shrinkage and selection operator (LASSO) regression were adopted for variable selection. The nomogram was formulated and validated by concordance indexes (C-indexes) and calibration curves. An in-stent restenosis risk table (ISR-RT) was subsequently generated for risk stratification. Differences between low-, intermediate-, and high-risk levels were shown by Kaplan-Meier curves and compared by log-rank test. RESULTS The training and validation set included 594 and 199 patients, with a mean ISR rate of 37.2% and 35.2%, respectively. Stent type (HR=1.64, 95% CI 1.26 to 2.14), stent diameter (HR=2.48, 95% CI 1.77 to 3.48), history of peripheral vascular disease (HR=2.17, 95% CI 1.17 to 4.00), history of transit ischemic attack (HR=1.45, 95% CI 1.05 to 2.14), and left-side involvement (HR=1.33, 95% CI 1.04 to 1.69) were included in the nomogram. The C-indexes at 6 and 12 months were 0.650 and 0.611 in the training set, and 0.713 and 0.603 in the validation set, respectively. Compared with low-risk patients, the intermediate- and high-level group had 1.46 (95% CI 1.05 to 2.04; p=0.0235) and 2.28 (95% CI 1.64 to 3.17; p<0.0001) higher chances of developing ISR in 2 years, respectively. CONCLUSIONS A nomogram and a risk evaluation table were developed with good predictive ability for in-stent restenosis among patients with VAOS, which could serve as a practical approach for individualized risk evaluation.
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Affiliation(s)
- Kun Yang
- Department of Epidemiology and Biostatistics, Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Evidence-based Medicine Center, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Shiyuan Fang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yiding Feng
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
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Nakagawa I, Yokoyama S, Kotsugi M. Human Basilar Arterial Plaque Detected by Near-Infrared Spectroscopy: Clinical Image. World Neurosurg 2023; 176:204-205. [PMID: 37224959 DOI: 10.1016/j.wneu.2023.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
A patient in their 70s presented with weakness of the left limb and aphasia. Left vertebral angiography showed acute basilar artery occlusion. After mechanical thrombectomy, basilar artery trunk stenosis was evident and catheter-based near-infrared spectroscopy (NIRS) showed lipid-rich atherosclerotic plaque extending to almost 220° of the vessel circumference in the culprit lesion. Loading doses of dual antiplatelet therapy and aggressive medical treatment were started because additional intervention might have increased risk of plaque protrusion and thrombotic reocclusion. The patient presented with minor stroke caused by restenosis of the basilar artery 4 months later; balloon angioplasty and stenting were performed without thromboembolic complications. The patient was discharged without any new neurologic deficits. NIRS visualizes the distribution of lipids in the culprit lesion and the plaque burden of residual stenosis, identifies mechanisms of in situ thrombosis, and provides suggestions for the timing of additional interventions.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan.
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Luo J, Bai X, Huang K, Wang T, Yang R, Li L, Tian Q, Xu R, Li T, Wang Y, Chen Y, Gao P, Chen J, Yang B, Ma Y, Jiao L. Clinical Relevance of Plaque Distribution for Basilar Artery Stenosis. AJNR Am J Neuroradiol 2023; 44:530-535. [PMID: 37024307 PMCID: PMC10171387 DOI: 10.3174/ajnr.a7839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND AND PURPOSE There is no clear association between plaque distribution and postoperative complications in patients with basilar artery atherosclerotic stenosis. The aim of this study was to determine whether plaque distribution and postoperative complications after endovascular treatment for basilar artery stenosis are related. MATERIALS AND METHODS Our study enrolled patients with severe basilar artery stenosis who were scanned with high-resolution MR imaging and followed by DSA before the intervention. According to high-resolution MR imaging, plaques can be classified as ventral, lateral, dorsal, or involved in 2 quadrants. Plaques affecting the proximal, distal, or junctional segments of the basilar artery were classified according to DSA. An experienced independent team assessed ischemic events after the intervention using MR imaging. Further analysis was conducted to determine the relationship between plaque distribution and postoperative complications. RESULTS A total of 140 eligible patients were included in the study, with a postoperative complication rate of 11.4%. These patients were an average age of 61.9 (SD, 7.7) years. Dorsal wall plaques accounted for 34.3% of all plaques, and plaques distal to the anterior-inferior cerebellar artery accounted for 60.7%. Postoperative complications of endovascular treatment were associated with plaques located at the lateral wall (OR = 4.00; 95% CI, 1.21-13.23; P = .023), junctional segment (OR = 8.75; 95% CI, 1.16-66.22; P = .036), and plaque burden (OR = 1.03; 95% CI, 1.01-1.06; P = .042). CONCLUSIONS Plaques with a large burden located at the junctional segment and lateral wall of the basilar artery may increase the likelihood of postoperative complications following endovascular therapy. A larger sample size is needed for future studies.
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Affiliation(s)
- J Luo
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - X Bai
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - K Huang
- The Eighth Affiliated Hospital (K.H.), SUN YAT-SEN University, Shenzhen, Guangdong Province, China
| | - T Wang
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - R Yang
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - L Li
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - Q Tian
- Xuanwu Hospital, Beijing Key Laboratory of Clinical Epidemiology (Q.T.), School of Public Health
| | - R Xu
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - T Li
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - Y Wang
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - Y Chen
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - P Gao
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
- Department of Interventional Radiology (P.G., L.J.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - J Chen
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - B Yang
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - Y Ma
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
| | - L Jiao
- From the China International Neuroscience Institute (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.), Beijing, China
- Department of Neurosurgery (J.L., X.B., T.W., R.Y., L.L., R.X., T.L., Y.W., Y.C., P.G., J.C., B.Y., Y.M., L.J.)
- Department of Interventional Radiology (P.G., L.J.), Xuanwu Hospital, Capital Medical University, Beijing, China
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Abbas R, Chen CJ, Atallah E, El Naamani K, Amllay A, Sioutas G, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Tjoumakaris S. Mechanical Thrombectomy for Stroke Due to Acute Basilar Artery Occlusion, a Safety and Efficacy Analysis. Neurosurgery 2023; 92:772-778. [PMID: 36513024 DOI: 10.1227/neu.0000000000002261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute basilar artery occlusion accounts for 1% of all ischemic strokes but often leads to devastating neurological injury and mortality. Many institutions still opt for best medical therapy for these patients; however, there is increasing evidence that mechanical thrombectomy (MT) for these patients leads to better outcomes. OBJECTIVE To assess the safety and efficacy of MT for patients presenting with acute basilar artery occlusion (BAO). METHODS This study was a retrospective chart review of a prospectively maintained database for patients with acute BAO treated with MT from January 2014 through March 2022. RESULTS Our study included a total of 74 patients. The mean age was 62.7 years, and 55.4% were male. The most common comorbidity was hypertension (73%). The mean door to puncture time was 75 minutes, and the mean procedure time was 54 minutes. 86.5% of patients had a good modified treatment in cerebral ischemia score (≥2b). There were 4 patients who had procedural complications and 3 who had symptomatic intracerebral hemorrhage. At 90 days, 62.5% of patients had a modified Rankin Scale, 0 to 3. The mortality rate was 32.4% and 2% during hospital admission and 90 days, respectively. On univariate analysis, adjunctive angioplasty/stenting and higher presenting National Institutes of Health Stroke Scale score were associated with modified Rankin Scale 4 to 6 at 90 days ( P -value, .03 and <.001, respectively). Shorter procedure time was associated with modified treatment in cerebral ischemia score ≥ 2b ( P -value, .0015). CONCLUSION Our findings showed that MT is safe and effective for patients presenting with acute BAO and is in conjunction with previous literature. The results from upcoming trials should hopefully establish MT as gold standard for these patients.
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Affiliation(s)
- Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Beloyartsev DF, Adyrkhaev ZA, Fagamov RR. [Treatment of atherosclerotic lesion of the first segment of subclavian artery]. Khirurgiia (Mosk) 2023:95-102. [PMID: 38088846 DOI: 10.17116/hirurgia202312195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.
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Affiliation(s)
- D F Beloyartsev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Z A Adyrkhaev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - R R Fagamov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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El Malky I, Hendi AM, Abdelkhalek HM. Basilar Artery Thrombectomy Between Evidence-Based Medicine and the Real-World Practice: A Single-Center Experience. Neurol India 2022; 70:2111-2115. [PMID: 36352617 DOI: 10.4103/0028-3886.359163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Basilar artery occlusion (BAO) is known for its catastrophic outcomes, whether death or disability, in approximately 70% of patients. Mechanical thrombectomy (MT) has been approved as an intervention in large vessel occlusion of anterior circulation, based on multiple randomized controlled trials (RCTs) and meta-analyses. Even though two RCTs appeared recently, there is still uncertainty about the effect of MT in BAO. Our study aims to report the outcome of MT in BAO and the variables affecting good outcomes and mortality rate. MATERIALS AND METHODS We retrospectively collected the clinical and radiological data of 30 BAO patients treated in our center by MT between July 2016 and July 2021. A favorable clinical outcome was considered if mRS was ≤2. A favorable radiological result was considered if modified Thrombolysis in Cerebral Infarction (mTICI) was ≥2b at the end of the intervention. Multiple variables were tested for their effects on favorable clinical outcomes and mortality. RESULTS The mean age of the 30 patients was 61.23 ± 16.81 years; 20/30 (66.7%) were male. A favorable functional outcome was achieved in 40.7%. Successful revascularization was achieved in 26 patients (86.7%). Mortality at 90 days was observed in 11 patients (36.7%). The presenting National Institute of Health and Stroke Scale (NIHSS) was the only predictor of mortality, and the optimal cut-off value for death was 15 with area under the curve (AUC) = 0.758 (sensitivity 91% and specificity 59%) and P value = 0.02. CONCLUSION Thrombectomy is an effective procedure in BAO which has naturally a bad outcome. The presenting NIHSS might be the only predictor of mortality in our study.
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Affiliation(s)
- Islam El Malky
- Department of Neurology, South Valley University, Qena, Egypt
| | - Ali Mo Hendi
- Department of Radiology, Jazan University, Saudi Arabia
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Phuong NV, Cong Thanh N, Keserci B, Sang NV, Minh Duc N. Mechanical thrombectomy treatment of basilar artery occlusion within 24 hours of symptom onset: A Single-Center Experience. Clin Ter 2022; 173:400-406. [PMID: 36155724 DOI: 10.7417/ct.2022.2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND To evaluate the efficacy, safety, and predictive factors for clinical outcomes of mechanical thrombectomy (MT) performed within 24 hours of stroke onset in patients with basilar artery occlusion (BAO). METHOD A prospective, single-center study collected clinical and imaging data from 49 patients with BAO treated with MT within 24 hours of stroke symptom onset. Direct suction using the Penumbra system and thrombus retrieval by Solitaire stent were the primary endovascular techniques used to restore basilar artery flow. Outcomes included angiographic recanalization success, improvement National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) at discharge and after 3 months, and occurrence of symptomatic intracerebral hemorrhage (sICH) complications. RESULTS The mean age was 67.6 ± 10.4 years (range, 47-88 years). The mean NIHSS and Glasgow Coma Scale (GCS) on admission were 22.9 ± 11.2 (range, 6-40) and 10.4 ± 3.1 (range, 5-15), respectively. The major etiologic risk factors were large artery atherosclerosis (83.7%), followed by cardioembolism (16.3%). Successful recanalization (thrombolysis in cerebral infarction [TICI] ≥ 2b) was achieved in all patients (100%), and TICI 3 was achieved in 93.9% of patients. Of the total sample, 6.1% (3/49) of patients showed NIHSS improve-ments of 0 points at discharge, and 24.9% (12/49) of patients showed NIHSS improvements of 10 points at discharge. After 3 months, 22 patients (44.9%) had favorable clinical outcomes (mRS 0-2), whereas 7 (14.3%) had poor outcomes (mRS 3-5); overall mortality was 40.8% (20/49). Complications of sICH were documented in 15.6% of patients. Univariate analysis identified atrial fibrillation (P = 0.016), NIHSS on admission < 15 (P = 0.032), and GCS on admission > 8 (P = 0.010) as predictive factors for favorable outcomes. CONCLUSIONS The current study suggests that MT treatment of BAO has high recanalization rates and good outcomes.
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Affiliation(s)
- N V Phuong
- Department of Emergency, 108 Military Central Hospital, Hanoi, Vietnam
| | - N Cong Thanh
- Department of Emergency, 108 Military Central Hospital, Hanoi, Vietnam
| | - B Keserci
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - N V Sang
- Department of Radiology, Medlatec Hospital, Hanoi, Vietnam
- Department of Radiology, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
- Department of Radiology, E Hospital, Hanoi, Vietnam
| | - N Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Markus HS. Posterior circulation stroke from diagnosis to management, including recent data on thrombectomy for basilar artery occlusion from the BAOCHE and ATTENTION trials. Int J Stroke 2022; 17:712-713. [PMID: 35929195 DOI: 10.1177/17474930221115892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cai X, Chen X, Xiang Y, Chen L, Sun J. Balloon-Assisted Angioplasty for the Treatment of In-Stent Restenosis After Vertebral Artery Ostium Stenting: Experiences From One Single Center. Neurologist 2022; 27:106-110. [PMID: 34842576 PMCID: PMC9067090 DOI: 10.1097/nrl.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stenting appears to be a safe means of treatment for vertebral artery ostium stenosis with low complication rates and positive long-term effects, but the incidence of in-stent restenosis (ISR) after stenting is high. Different treatment strategies are applied for the revascularization of ISR; however, currently the optional approach is not recommended. The study was designed to investigate the feasibility, safety, and effectiveness of balloon-assisted angioplasty for the treatment of ISR after vertebral artery ostium stenosis. METHODS In this study, we included patients from the Department of Neurology, Lishui Hospital of Zhejiang University, who were treated with balloon-assisted angioplasty as a result of suffering from ISR after previously undergoing vertebral artery ostium stenting. We retrospectively analyzed the clinical and functional outcomes of the patients. RESULTS From January 2015 to December 2019, 11 patients were included in the study. The technical success rate reached 100% and the average operation time was 73 minutes. The Thrombolysis in Cerebral Infarction Score 2b-3 was acquired in all patients except 1 patient, who was presented with symptoms of hypoperfusion syndrome. The remaining 10 patients did not experience any intraoperative or postoperative complications. No restenosis, new cerebral infarction or transient ischemic attack were reported within 6 months of follow-up. CONCLUSION Balloon-assisted angioplasty could be feasible for the treatment of ISR after vertebral artery ostium stenting, however, more research is needed to confirm this.
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Affiliation(s)
- Xueli Cai
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Xueping Chen
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Yian Xiang
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Liujing Chen
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
| | - Jingping Sun
- Department of Neurology, Lishui Hospital of Zhejiang University (The Central Hospital of Lishui)
- Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang Province, China
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Lin CM, Chang CH, Wong HF. Management of intracranial vertebral artery stenosis with ipsilateral vertebral artery hypoplasia and contralateral vertebral artery occlusion via type 2 proatlantal intersegmental artery. Biomed J 2021; 44:369-372. [PMID: 34130943 PMCID: PMC8358211 DOI: 10.1016/j.bj.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/20/2019] [Accepted: 02/10/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Proatlantal intersegmental artery (PIA) is a rare primitive carotid-basilar anastomosis. PIA may accompany with ipsilateral or bilateral vertebral arteries (VAs) agenesis. Here, we presented the case with intracranial VA stenosis supplying via PIA and demonstrated how we evaluated and managed. METHODS Dual antiplatelet therapy and adequate hydration were given for three weeks for intracranial atherosclerotic disease (ICAD). We arranged magnetic resonance (MR) vessel wall imaging to survey both intracranial VAs. Intracranial right VA stenosis supplying via PIA with ipsilateral VA hypoplasia and contralateral intracranial VA occlusion caused multiple posterior circulation infarcts. We performed angioplasty and intracranial stenting for ICAD at the right VA V4 segment via PIA. RESULTS National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) got improved at discharge and ten months. CONCLUSIONS This case is the first report for ICAD management via PIA. A persistent type 2 PIA is essential for supplying posterior circulation.
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Affiliation(s)
- Chuan-Min Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ho-Fai Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Li H, Chen C, Li Z, Ling C, Sun J, Wang H. Superficial Temporal Artery-Posterior Cerebral Artery Bypass for the Treatment of Chronic Basilar Artery Occlusion. World Neurosurg 2021; 150:e45-e51. [PMID: 33631388 DOI: 10.1016/j.wneu.2021.02.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effect of superficial temporal artery-posterior cerebral artery (STA-PCA) bypass on chronic basilar artery occlusion (CBAO). METHODS A total of 4 patients who underwent STA-PCA bypass between January 2018 and October 2019 were enrolled in this study. Cerebral blood perfusion, ischemic events, STA diameter and blood flow changes, modified Rankin scale score (mRS), and National Institutes of Health Stroke Scale (NIHSS) score changes were recorded before and after bypass surgery. RESULTS The average time from basilar artery occlusion (confirmed by cerebral angiography or computed tomography angiography) to operation was 76 ± 38.89 days (range: 30-120 days). Average scores on the NIHSS were 6.8 ± 1.26 (5-8) and 5.2 ± 2.06 (3-7) before and after treatment, respectively. mRS scores averaged 1.8 ± 0.5 (1-2) and 1.5 ± 0.58 (1-2) points, respectively. There were no obvious complications or further stroke during the follow-up. The STA diameter and flow rate were significantly increased at 12 months after operation (P < 0.05). CONCLUSIONS STA-PCA bypass can improve cerebral blood flow perfusion in CBAO patients. The diameter and flow of the superficial temporal artery can be increased to meet the demand of blood supply.
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Affiliation(s)
- Hao Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhangyu Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Cong Ling
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Sun
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Plitt AR, Patel AR, McDougall CM, Halderman AA, Barnett SL, Welch BG. Combined Microsurgical, Endovascular, and Endoscopic Approach to the Treatment of a Giant Vertebrobasilar Aneurysm. Oper Neurosurg (Hagerstown) 2020; 17:149-156. [PMID: 30476195 DOI: 10.1093/ons/opy341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/01/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dolichoectasia is defined as elongation and dilatation of a blood vessel. In the intracranial circulation, the basilar artery is affected in 80% of cases. These are challenging lesions with an aggressive natural history, and treatment carries a relatively high rate of morbidity and mortality. We describe a case of multimodal treatment including endovascular, open microsurgical, and endoscopic endonasal approach (EEA) for management. OBJECTIVE To describe the technical nuance of the addition of the EEA for management of posterior circulation dolichoectasia. METHODS A 44-yr-old Hispanic woman with a 2-mo history of progressive headaches, gait disturbance, and lower cranial nerve dysfunction presented with acute neurologic decline. MRI demonstrated a dolichoectatic vertebrobasilar system with a giant 4.5-cm fusiform basilar aneurysm. RESULTS She underwent concomitant endovascular bilateral vertebral artery sacrifice with suction decompression and trapping by clip ligation distal to the lesion. Postoperatively, she developed symptomatic pontine compression. She was then taken for a transclival EEA for intra-aneurysmal thrombectomy. Thereafter, she made a significant functional recovery. CONCLUSION The addition of endoscopic reconstruction to the treatment of a dolichoectatic basilar aneurysm is an operative nuance that can be employed in treating these highly morbid lesions. This case describing a multimodal treatment paradigm including EEA reconstruction can serve as an example for the future of treatment select cases of dolichoectasia of the vertebrobasilar complex.
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Affiliation(s)
- Aaron R Plitt
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas
| | - Ankur R Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas
| | - Cameron M McDougall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas
| | - Ashleigh A Halderman
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas
| | - Samuel L Barnett
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas
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Xu C, Wang F, Lv P, Zhang X, Tang G. Endovascular treatment combined with vertebral artery endarterectomy for patients with acute tandem vertebrobasilar artery occlusion. J Clin Neurosci 2020; 79:21-29. [PMID: 33070898 DOI: 10.1016/j.jocn.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of endovascular treatment combined with vertebral artery endarterectomy in patients with acute tandem vertebrobasilar artery occlusion. METHODS From April 2017 to March 2019, three patients with acute basilar artery occlusion combined with ostial vertebral occlusion in our institution were enrolled in the study. They underwent endovascular treatment combined with vertebral artery endarterectomy. The clinical, technical and functional outcomes of the patients were retrospectively analysed. RESULTS All three patients in the study underwent complete recanalization. The modified Thrombolysis in Cerebral Infarction (mTICI) grade was 2b/3 in all patients. The modified Rankin Scale (mRS) score was 0-2 for the three patients at 3 months. Follow-up CT scans revealed no cerebral haemorrhage, and no patients died during follow-up. All patients achieved good clinical outcomes after the combined treatment. CONCLUSION Endovascular treatment combined with vertebral artery endarterectomy is a feasible method to treat patients with acute basilar artery occlusion combined with ostial vertebral occlusion, especially when the guidewire cannot pass through the ostium of the dominant vertebral artery occlusion.
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Affiliation(s)
- Chuan Xu
- Department of Radiology, Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University, No. 301 Yanchang Road, Shanghai 200072, China
| | - Fuan Wang
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China
| | - Penghua Lv
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Clinical Hospital of Nanjing Medical University, No. 98 Nantong Road, Yangzhou 225001, Jiangsu, China
| | - Xicheng Zhang
- Department of Vascular Surgery, Northern Jiangsu People's Hospital, Clinical Hospital of Nanjing Medical University, No. 98 Nantong Road, Yangzhou 225001, Jiangsu, China
| | - Guangyu Tang
- Department of Radiology, Clinical Medical College of Shanghai Tenth People's Hospital of Nanjing Medical University, No. 301 Yanchang Road, Shanghai 200072, China.
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Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Maeda K, Ikai Y, Gi H. Mechanical Thrombectomy for Basilar Artery Occlusion Compared with Anterior Circulation Stroke. World Neurosurg 2019; 134:e469-e475. [PMID: 31669246 DOI: 10.1016/j.wneu.2019.10.097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the clinical effectiveness of mechanical thrombectomy (MT) for basilar artery occlusion (BAO) and to ascertain whether outcomes for patients with BAO were comparable to those with anterior circulation large vessel occlusion (ACS). METHODS A total of 345 patients who underwent MT between 2011 and 2018 were grouped by occlusion site (295 patients with ACS and 50 patients with BAO). Patients' baseline characteristics, procedural times, complications, symptomatic intracranial hemorrhage, modified Rankin Scale score, and mortality at 90 days were analyzed. RESULTS Male preponderance (66.0% vs. 48.8%; P = 0.0316), younger age (72.5 years [interquartile range (IQR), 64.75-78.5 years] vs. 77 years [IQR 69-84 years]; P = 0.0297), higher National Institutes of Health Stroke Scale score (24.5 [IQR, 13-32] vs. 18 [IQR 13-22]; P = 0.0015) and higher reperfusion rate (100% vs. 84.7%; P = 0.0010) were observed in patients with BAO. We found no significant difference in favorable outcomes (modified Rankin Scale score ≤2) between patients with BAO and patients with ACS (64.3% vs. 49.3%; P = 0.0914). In multivariate analysis, Alberta Stroke Program Early Computed Tomography Score (odds ratio [OR], 1.282; 95% confidence interval [CI], 1.090-1.524; P = 0.0024), time from onset to reperfusion (OTR) (OR, 0.9950; 95% CI, 0.992-0.998; P = 0.0008), successful reperfusion (OR, 6.953; 95% CI, 1.576-48.729; P = 0.0092), and hemorrhagic complication (OR, 0.352; 95% CI, 0.151-0.797; P = 0.0122) were associated with a favorable outcome at 90 days in patients with ACS. In patients with BAO, only OTR (OR, 0.9879; 95% CI, 0.974-0.999; P = 0.0314) was associated with a favorable outcome at 90 days. CONCLUSIONS MT may be considered the standard care for patients with BAO. OTR was the only common significant predictor for favorable outcomes in both patient cohorts.
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Affiliation(s)
- Junji Uno
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan.
| | - Katsuharu Kameda
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Ryosuke Otsuji
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Nice Ren
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Shintaro Nagaoka
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Kazushi Maeda
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Yoshiaki Ikai
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Hidefuku Gi
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
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Abstract
RATIONALE Dolichoectasia of the vertebrobasilar artery is a vascular anomaly characterized by marked elongating, widening, and tortuosity of the arteries. Although this anomaly is usually asymptomatic, it may present with ischemic symptoms or mass effect involving brainstem or cranial nerves. PATIENT CONCERNS A 52-year-old male was admitted with headache and visual field defect. DIAGNOSES Computed tomography and magnetic resonance imaging showed noncommunicating hydrocephalus due to vertebrobasilar dolichoectasia. INTERVENTIONS The patient underwent right-side ventriculoperitoneal shunt. OUTCOMES The patient's symptoms improved gradually, although visual symptoms persisted. LESSONS Neurosurgeons need to keep in mind vertebrobasilar dolichoectasia as a rare cause of obstructive hydrocephalus for accurate diagnosis and swift treatment.
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Rennert RC, Steinberg JA, Strickland BA, Ravina K, Bakhsheshian J, Fredrickson V, Pannell JS, Khalessi AA, Russin JJ. Extracranial-to-Intracranial Bypass for Refractory Vertebrobasilar Insufficiency. World Neurosurg 2019; 126:552-559. [PMID: 30926554 DOI: 10.1016/j.wneu.2019.03.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vertebrobasilar insufficiency (VBI) is associated with high rates of morbidity and mortality, especially after failure of first-line medical and/or endovascular therapies. Although the optimal therapeutic strategy for refractory VBI remains unclear, surgical bypass represents a potentially life-saving treatment in this patient subset. METHODS A multi-institution retrospective database review was performed to identify patients with symptomatic refractory VBI over a 4-year period (July 2014 to July 2018). Surgical treatments, as well as clinical and neurologic outcomes were recorded. RESULTS Five patients were identified with refractory VBI (average age 55 ± 11.0 years). All 5 patients had clinically significant posterior circulation strokes on presentation. Three patients underwent superficial temporal artery-to-superior cerebellar artery bypass based on significant acute perfusion mismatches or progressive strokes despite maximal medical therapy; 1 surgical patient (33%) experienced punctate perioperative strokes and there were no significant bypass related complications. Functional outcomes in the 3 surgical patients were correlated with preoperative stroke burden. The remaining 2 patients experienced rapid neurologic declines after presentation that precluded bypass, and died shortly thereafter. CONCLUSIONS Refractory VBI has high morbidity, with cerebral bypass representing a safe and potentially efficacious treatment for selected patients. Long-term post-bypass outcomes are dependent on the level of irreversible preoperative neurologic injuries.
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Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Jeffrey A Steinberg
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Vance Fredrickson
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J Scott Pannell
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Alexander A Khalessi
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Abstract
Compression syndromes of the vertebral artery that occur at the craniocervical junction are extremely rare causes of haemodynamic insufficiency of the posterior cerebral circulation. The aetiology of the compression syndrome may be a malformation, trauma, tumour, infection or degenerative pathology. This may lead to dynamic vertebral artery occlusion where the vessel courses around the atlas and the axis-the so-called V3 segment. This in turn may result in insufficient collateral flow to the posterior fossa. The clinical picture is a vertebrobasilar insufficiency syndrome of variable expression ranging from vertigo to posterior fossa stroke. The typical clinical presentation is syncope occurring during rotation of the head, also known as 'bow hunter's syndrome'. The workup is based on dynamic angiography and computed tomography angiography. The treatment of choice is surgical vascular decompression, resulting in a good clinical outcome. However, in some instances, atlantoaxial fusion may be indicated. Alternatively, conservative and endovascular options have to be considered in inoperable patients.
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Affiliation(s)
| | - Raoul Pop
- Service de neuroradiologie interventionnelle, CHU, Strasbourg, France
| | - Marco Fricia
- Neurosurgery Department, Cannizzaro Hospital, Catania, Italy
| | - Bernard George
- Service de neurochirurgie, CHU Lariboisiere, Paris, France
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Arai T, Yamaguchi K, Ishikawa T, Okada Y, Matsuoka G, Omura Y, Kawamata T. Decompression by Cutting the Tentorium for Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia. World Neurosurg 2018; 120:72-77. [PMID: 30098437 DOI: 10.1016/j.wneu.2018.07.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Trigeminal neuralgia caused by vertebrobasilar dolichoectasia (VBD) is rare and challenging to treat. Some authors have reported techniques for treating trigeminal neuralgia caused by VBD using various kinds of objects including clips, Proline slings, and titanium plates. METHODS Here, we report the effectiveness of cutting and splitting of the tentorium in 3 patients with trigeminal neuralgia. RESULTS The clinical results were good, the pain disappeared in all patients without medication, and no complications occurred. CONCLUSIONS In cases of trigeminal neuralgia caused by VBD, this technique may be as useful as traditional microvascular decompression around the trigeminal nerve root entry zone.
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Affiliation(s)
- Takashi Arai
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Go Matsuoka
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Omura
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Komatani H, Okamoto Y, Aoki T, Noguchi K, Morioka M. Long-term Prognosis after Extracranial-intracranial Bypass Surgery for Symptomatic Cerebrovascular Occlusive Disease. Kurume Med J 2018; 64:1-4. [PMID: 28603158 DOI: 10.2739/kurumemedj.ms6400016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prognosis after extracranial-intracranial (EC-IC) bypass surgery has only been studied for a few years and the benefits of this procedure are still controversial. In this single-center retrospective study, we examined the long-term prognosis of patients who underwent EC-IC bypass surgery. Subjects were patients with symptomatic internal carotid artery or intracranial lesion occlusive disease who underwent EC-IC bypass surgery between 1991 and 2003. Of these, long-term prognosis was examined in 57 patients (39 male, 18 female; mean age, 61.8 years) who showed good surgical outcomes 30 days after bypass surgery, measured as a 0-2 on the modified Rankin Scale (mRS). They were divided into 2 groups (survivors and non-survivors) and were analyzed to identify factors effecting long-term survival after bypass surgery. Sixteen patients (28%), whose mean follow-up period (survival time) was 8.3±3.8 years, died after the bypass surgery. The average follow-up period for the survivors was 12.0±1.1 years, which was significantly longer than that for the non-survivors (P<0.0001). At surgery, the non-survivors (mean age 71.5 years) were significantly older than the survivors (P=0.0012). Pneumonia and other respiratory diseases were a frequent cause of death (31.2%), but death by cerebrovascular disease also occurred (12.5%). The rate of recurrent ischemic stroke was 28%, with no significant difference between groups (survivors vs. non-survivors: 31.2% vs. 26.1%, P= 0.82). In the absence of perioperative complications, the long-term prognosis of patients who underwent EC-IC bypass surgery was very good.
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Affiliation(s)
- Hideki Komatani
- Department of Neurosurgery, Saiseikai Yahata General Hospital
| | - Yuji Okamoto
- Department of Neurosurgery, Saiseikai Yahata General Hospital
| | - Takachika Aoki
- Department of Neurosurgery, Kurume University School of Medicine
| | - Kei Noguchi
- Department of Neurosurgery, Kurume University School of Medicine
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine
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46
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Vachev AN, Dmitriev OV, Stepanov MY, Frolova EV. [Efficacy of carotid endarterectomy in patients with vertebrobasilar insufficiency without significant lesion of vertebral arteries]. Angiol Sosud Khir 2018; 24:104-108. [PMID: 30531777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The authors examined efficacy of carotid endarterectomy (CEA) in treatment of patients suffering from vertebrobasilar insufficiency (VBI) without significant involvement of the vertebral arteries. The study included a total of 297 patients with VBI and diagnosed as having stenosis of the bifurcation of the carotid arteries amounting to 70% and more, with no significant involvement of the vertebral arteries revealed. All patients underwent CEA: eversion CEA was performed in 226 (76.1%) cases and the classical one in 71 (23.9%) cases. On postoperative day 10, clinical improvement in the form of decreased severity of VBI was observed in 152 (51.2%) patients. One year after surgery, improvement persisted in 135 (45.5%) patients and after 3 years in 125 (42%) patients. Prognostic factors of unsatisfactory clinical outcomes were determined. It was demonstrated that in VBS, CEA is clinically efficient only if the circle of Willis is closed and there is no history of stroke in the vertebrobasilar basin. Besides, the outcome of the operation appeared to have been influenced by such factor as the duration of hypertension and diabetes mellitus. No effect of either cardiac arrhythmia or the technique of CEA on the results of treatment was observed.
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Affiliation(s)
- A N Vachev
- Clinic of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - O V Dmitriev
- Clinic of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - M Yu Stepanov
- Clinic of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - E V Frolova
- Clinic of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
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47
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Vachev AN, Dmitriev OV, Stepanov MI, Tereshina OV. [Clinical efficacy of reconstructive operations on the third (V3) segment of the vertebral artery]. Angiol Sosud Khir 2018; 24:139-145. [PMID: 29688207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Presented herein are the results of a prospective cohort study of clinical efficacy of medicamentous treatment and operations of shunting to the third segment (V3) of the vertebral artery in patients with vertebrobasilar insufficiency (VBI). The study included a total of 60 patients with pronounced clinical manifestations of VBI and concomitant lesions of the V1 and V2 segments of the vertebral arteries. The patients were found to have no significant involvement of the carotid bifurcation. At the first stage, all patients during 12 months were receiving a course of optimal medicamentous therapy. Clinical improvement was observed in only 3 (5%) patients, and they were not subjected to surgery. The remaining 57 patients with no improvement after the course of conservative therapy underwent a second-stage treatment consisting in shunting to the third (V3) segment of the vertebral artery. Of these, 5 patients underwent arterial bypass grafting and 52 patients endured autovenous shunting. In the early postoperative period one patient developed thrombosis of the autovenous shunt. This patient died of repeat stroke into the trunk of the brain. In 56 patients the shunts were patent. Clinical improvement was observed in all 56 patients during 3-month follow-up. By month 12, all 5 patients with autoarterial shunts developed shunt thrombosis and were found to have a return of the clinical course of VBI, with no events of either acute impairment of cerebral circulation or transitory ischaemic attacks. We managed to mitigate the clinical course of VBI in 51 (85%) patients with autovenous shunts, with this effect persisting for 12 months and more after the operation. The differences between the results of medicamentous and surgical treatment were statistically significant (p≤0.01). During 3 years of follow up the achieved improvement persisted in 88.7% of the surgically treated patients and during 7 years in 78.3% of patients, with the 3- and 7-year shunt patency rate amounting to 90.2 and 88.2%, respectively.
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Affiliation(s)
- A N Vachev
- Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - O V Dmitriev
- Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - M Iu Stepanov
- Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - O V Tereshina
- Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
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Wang MY, Liu YS, Li K, Liu YJ, Wang F. Protective effect of the microcatheter placed at the normal vertebral artery in intracranial stent-assisted angioplasty for vertebral artery stenosis: A case report. Medicine (Baltimore) 2017; 96:e7569. [PMID: 28723788 PMCID: PMC5521928 DOI: 10.1097/md.0000000000007569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE A carefully designed intracranial stent-assisted angioplasty (SAA) is presented here that may prevent subsequent branch artery occlusion. PATIENT CONCERNS A 72-year-old man with a 3-month history of progressive and intermittent vertigo without any obvious trigger, accompanied by nausea. DIAGNOSES Intracranial atherosclerotic disease. INTERVENTIONS the patient underwent intracranial SAA in accordance with the procedure described here. OUTCOMES The patient's paroxysmal vertigo completely subsided, with no complications during the short-term follow-up. LESSONS This novel intracranial SAA procedure is safe and may reduce the risk of subsequent artery occlusion.
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49
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Dmitriev OV, Vachev AN, Stepanov MI, Vovk TI, Kutsenko VV, Krugomov AV, Tereshina OV. Treatment of vertebrobasilar insufficiency due to stenosis and aneurysm of the vertebral artery. Angiol Sosud Khir 2017; 23:108-117. [PMID: 28594803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A dissecting aneurysm of the vertebral artery in the extracranial portion is a rare pathology. It may either have a symptom-free course or induce a clinical picture of vertebrobasilar insufficiency. To the main methods of surgical treatment belong endovascular techniques and resection of an aneurysm with shunting of the V3 segment of the vertebral artery. Presented in the article is a clinical case report regarding successful surgical management of a dissecting aneurysm of the extracranial portion in a young woman presenting with a clinical course of vertebrobasilar insufficiency and treated by means of ligation of the vertebral artery in the V1 segment and autovenous shunting from the external carotid artery to the V3 segment of the vertebral artery.
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Affiliation(s)
- O V Dmitriev
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - A N Vachev
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - M Iu Stepanov
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - T Iu Vovk
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - V V Kutsenko
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - A V Krugomov
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - O V Tereshina
- Samara State Medical University of the RF Public Health Ministry, Samara, Russia
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Vachev AN, Dmitriev OV. The operative technique of shunting to the third (V3) segment of the vertebral artery. Angiol Sosud Khir 2017; 23:98-110. [PMID: 28902820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The authors provide a detailed description of the step-by-step technique of performing the operation of shunting to the V3 segment of the vertebral artery in patients with clinical manifestations of vertebrobasilar insufficiency (VBI). Reported are surgical outcomes in a total of 57 patients with VBI. Of these, 5 patients underwent arterial bypass grafting and 52 patients endured autovenous shunting. One patient developed shunt thrombosis in the early postoperative period and, unfortunately, died, with the remaining 51 shunts being patent. At 3 years of follow up, shunt thrombosis occurred in four (80%) patients with the arterial bypass and only in one (1.7%) of the 52 autovein-treated patients. The total duration of postoperative follow up amounted to 10 years. Long-term freedom from VBI clinical manifestations was achieved in 88.7 % of patients after 3 years and in 78.3% after 7 years, with the 3- and 7-year patency rate of the autovenous shunts amounting to 98.1 and 96.2%, respectively.
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Affiliation(s)
- A N Vachev
- Clinic and Chair of Hospital Surgery of the Samara State Medical University of the RF Public Health Ministry, Samara, Russia
| | - O V Dmitriev
- Clinic and Chair of Hospital Surgery of the Samara State Medical University of the RF Public Health Ministry, Samara, Russia
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