Abstract
Introduction
Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported.
Methods
Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated.
Results
Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0–2], and the other 11 had poor outcomes (mRS 3–6). Five of six patients who scored 9–14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3–8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site.
Conclusions
Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization.
Similar content being viewed by others
References
Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222
Becker KJ, Monsein LH, Ulatowski J, Mirski M, Williams M, Hanley DF (1996) Intra-arterial thrombolysis in vertebrobasilar occlusion. AJNR Am J Neuroradiol 17:255–262
Brandt T, von Kummer R, Muller-Kuppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27:875–881
Cross DT 3rd, Moran CJ, Akins PT, Angtuaco EE, Diringer MN (1997) Relationship between clot location and outcome after basilar artery thrombolysis. AJNR Am J Neuroradiol 18:1221–1228
Eckert B, Kucinski T, Pfeiffer G, Groden C, Zeumer H (2002) Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. Cerebrovasc Dis 14:42–50
Zeumer H, Freitag HJ, Zanella F, Thie A, Arning C (1993) Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (r-TPA). Neuroradiology 35:159–162
Khatri P, Neff J, Broderick JP, Khoury JC, Carrozzella J, Tomsick T (2005) Revascularization end points in stroke interventional trials: recanalization versus reperfusion in IMS-I. Stroke 36:2400–2403
Arnold M, Nedeltchev K, Schroth G, Baumgartner RW, Remonda L, Loher TJ, Stepper F, Sturzenegger M, Schuknecht B, Mattle HP (2004) Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. J Neurol Neurosurg Psychiatry 75:857–862
Ezaki Y, Tsutsumi K, Onizuka M, Kawakubo J, Yagi N, Shibayama A, Toba T, Koga H, Miyazaki H (2003) Retrospective analysis of neurological outcome after intra-arterial thrombolysis in basilar artery occlusion. Surg Neurol 60:423–430
Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J, Alfke K, Jansen O, Zeumer H (2005) Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 36:1160–1165
Lindsberg PJ, Mattle HP (2006) Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 37:922–928
Nahser HC, Henkes H, Weber W, Berg-Dammer E, Yousry TA, Kuhne D (2000) Intracranial vertebrobasilar stenosis: angioplasty and follow-up. AJNR Am J Neuroradiol 21:1293–1301
Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, Branca V, Sit SP (2008) The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29:1409–1413
Mayer TE, Hamann GF, Brueckmann H (2002) Mechanical extraction of a basilar-artery embolus with the use of flow reversal and a microbasket. N Engl J Med 347:769–770
Mayer TE, Hamann GF, Schulte-Altedorneburg G, Bruckmann H (2005) Treatment of vertebrobasilar occlusion by using a coronary waterjet thrombectomy device: a pilot study. AJNR Am J Neuroradiol 26:1389–1394
Mangiafico S, Cellerini M, Nencini P, Gensini G, Inzitari D (2005) Intravenous glycoprotein IIb/IIIa inhibitor (tirofiban) followed by intra-arterial urokinase and mechanical thrombolysis in stroke. AJNR Am J Neuroradiol 26:2595–2601
Versnick EJ, Do HM, Albers GW, Tong DC, Marks MP (2005) Mechanical thrombectomy for acute stroke. AJNR Am J Neuroradiol 26:875–879
Chapot R, Houdart E, Rogopoulos A, Mounayer C, Saint-Maurice JP, Merland JJ (2002) Thromboaspiration in the basilar artery: report of two cases. AJNR Am J Neuroradiol 23:282–284
Cross DT 3rd, Moran CJ, Akins PT, Angtuaco EE, Derdeyn CP, Diringer MN (1998) Collateral circulation and outcome after basilar artery thrombolysis. AJNR Am J Neuroradiol 19:1557–1563
Spreer J, Els T, Hetzel A, Arnold S, Klisch J, Huppertz HJ, Oehm E, Schumacher M (2002) Primary stenting as emergency therapy in acute basilar artery occlusion. Neuroradiology 44:791–795
Phatouros CC, Higashida RT, Malek AM, Smith WS, Mully TW, DeArmond SJ, Dowd CF, Halbach VV (1999) Endovascular stenting of an acutely thrombosed basilar artery: technical case report and review of the literature. Neurosurgery 44:667–673
Callahan AS 3rd, Berger BL (2000) Basilar artery endoprosthesis placement: rescue therapy for recurrent thrombosis. J Neuroimaging 10:47–48
Levy EI, Hanel RA, Bendok BR, Boulos AS, Hartney ML, Guterman LR, Qureshi AI, Hopkins LN (2002) Staged stent-assisted angioplasty for symptomatic intracranial vertebrobasilar artery stenosis. J Neurosurg 97:1294–1301
Levy EI, Hanel RA, Boulos AS, Bendok BR, Kim SH, Gibbons KJ, Qureshi AI, Guterman LR, Hopkins LN (2003) Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery. J Neurosurg 99:653–660
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kashiwagi, J., Kiyosue, H., Hori, Y. et al. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty. Neuroradiology 52, 361–370 (2010). https://doi.org/10.1007/s00234-010-0658-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-010-0658-9