Management of Posterior Circulation Tandem Occlusions in Acute Ischemic Stroke: Recanalize the Dominant Vertebral Artery with Priority

Overview

Journal Interv Neuroradiol

Publisher Sage Publications

Specialty Neurology

Date 2022 Jul 25

PMID 35876354

Authors

Kun Liang

Bin Wang

Linbo Zhao

Yuezhou Cao

Lei Jiang

Qianghui Liu

Sheng Liu

Haibin Shi

Zhenyu Jia

Affiliations

Soon will be listed here.

Abstract

Purpose: To illustrate the characteristics of acute ostial vertebral artery (VA) and basilar artery (BA) tandem occlusions. The endovascular treatment strategy for ostial VA-BA tandem occlusion was reported.

Materials And Methods: We conducted a retrospective analysis of patients with ostial VA-BA tandem occlusion who underwent endovascular treatment in our center between November 2018 and February 2022. We preferred to recanalize the dominant vertebral artery with priority. The imaging characteristics, treatment strategy, clinical outcomes, and complications were analyzed.

Results: In total, 9 patients with ostial VA-BA tandem occlusion were enrolled in this study. All the VA-BA tandem occlusion was caused by acute occlusion of the dominant VA. Endovascular revascularization was performed through the occluded dominant VA in 8 patients and was performed through contralateral non-dominant VA in 1 patient. Successful recanalization (mTICI 2b/3 grade) was achieved in all 9 patients, and 5 patients (55.5%) achieved functional independence with a mRS score of 0-2 at 90 days.

Conclusions: In this case series, the occurrence of ostial VA-BA tandem occlusions was mainly caused by acute occlusion of the dominant VA. Endovascular revascularization of ostial VA-BA tandem occlusions through occluded dominant VA was feasible and recommended.

Citing Articles

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Rescue extracranial vertebral stenting in tandem occlusions: A preliminary Vietnamese study.

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Endovascular revascularization of vertebrobasilar tandem occlusions in comparison to isolated basilar artery occlusions: A multi-center experience.

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References

Cohen J, Leker R, Gomori J, Eichel R, Rajz G, Moscovici S . Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations-Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke. J Clin Neurosci. 2016; 34:70-76. DOI: 10.1016/j.jocn.2016.05.005. View

Shen G, Jia Z, Zhao L, Lu G, Liu S, Shi H . The safety and efficacy of a low dose of tirofiban for early complications during and after stent-assisted coiling of ruptured intracranial aneurysms: A propensity matching study. Clin Neurol Neurosurg. 2022; 214:107132. DOI: 10.1016/j.clineuro.2022.107132. View

Xing P, Zhang Y, Li Z, Zhang L, Shen H, Zhang Y . The "distal-to-proximal" strategy for the treatment of posterior circulation tandem occlusions: a single-centre experience. Neuroradiology. 2020; 62(7):867-876. DOI: 10.1007/s00234-020-02412-0. View

Piechowiak E, Kaesmacher J, Zibold F, Dobrocky T, Mosimann P, Jung S . Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion. J Neurointerv Surg. 2019; 12(1):25-29. DOI: 10.1136/neurintsurg-2019-014825. View

Shapiro M, Raz E, Nossek E, Chancellor B, Ishida K, Nelson P . Neuroanatomy of the middle cerebral artery: implications for thrombectomy. J Neurointerv Surg. 2020; 12(8):768-773. DOI: 10.1136/neurintsurg-2019-015782. View

Al-Ali F, Barrow T, Duan L, Jefferson A, Louis S, Luke K . Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke: result from borgess medical center vertebral artery ostium stenting registry. Stroke. 2011; 42(9):2544-9. DOI: 10.1161/STROKEAHA.110.610451. View

Yang H, Ma N, Zhang S, Huo X, Gao F, Sun X . Endovascular revascularisation of acute tandem vertebrobasilar artery occlusion: seven case series with literature reviews. Stroke Vasc Neurol. 2018; 3(1):17-21. PMC: 5870645. DOI: 10.1136/svn-2017-000125. View

Kim K, Fraser J, Grupke S, Cook A . Management of antiplatelet therapy in patients undergoing neuroendovascular procedures. J Neurosurg. 2017; 129(4):890-905. DOI: 10.3171/2017.5.JNS162307. View

Kim S, Choi J, Kang M, Cha J, Huh J . Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms. AJNR Am J Neuroradiol. 2015; 37(3):508-14. PMC: 7960136. DOI: 10.3174/ajnr.A4551. View

10.

Ecker R, Tsujiura C, Baker C, Cushing D . Endovascular reconstruction of vertebral artery occlusion prior to basilar thrombectomy in a series of six patients presenting with acute symptomatic basilar thrombosis. J Neurointerv Surg. 2013; 6(5):379-83. DOI: 10.1136/neurintsurg-2013-010719. View

11.

Siebert E, Bohner G, Zweynert S, Maus V, Mpotsaris A, Liebig T . Revascularization Techniques for Acute Basilar Artery Occlusion : Technical Considerations and Outcome in the Setting of Severe Posterior Circulation Steno-Occlusive Disease. Clin Neuroradiol. 2018; 29(3):435-443. DOI: 10.1007/s00062-018-0683-3. View

12.

Chang J, Jung S, Jung C, Bae H, Kwon O, Han M . Dominant vertebral artery status and functional outcome after endovascular therapy of symptomatic basilar artery occlusion. J Neuroradiol. 2017; 44(2):151-157. DOI: 10.1016/j.neurad.2016.12.001. View

13.

Weinberg J, Sweid A, Sajja K, Abbas R, Asada A, Kozak O . Posterior circulation tandem occlusions: Classification and techniques. Clin Neurol Neurosurg. 2020; 198:106154. DOI: 10.1016/j.clineuro.2020.106154. View

14.

Nishikata M, Hirashima Y, Tomita T, Futatsuya R, Horie Y, Endo S . Measurement of basilar artery bending and elongation by magnetic resonance cerebral angiography: relationship to age, sex and vertebral artery dominance. Arch Gerontol Geriatr. 2004; 38(3):251-9. DOI: 10.1016/j.archger.2003.10.006. View

15.

Maus V, Brehm A, Tsogkas I, Henkel S, Psychogios M . Stent retriever placement in embolectomy: the choice of the post-bifurcational trunk influences the first-pass reperfusion result in M1 occlusions. J Neurointerv Surg. 2018; 11(3):237-240. DOI: 10.1136/neurintsurg-2018-014114. View

16.

Baik S, Park H, Kim J, Jang C, Kim B, Kim D . Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome. Radiology. 2019; 291(3):730-737. DOI: 10.1148/radiol.2019181924. View

17.

Baik S, Jung C, Kim B, Kim D . Mechanical Thrombectomy for Tandem Vertebrobasilar Stroke: Characteristics and Treatment Outcome. Stroke. 2020; 51(6):1883-1885. DOI: 10.1161/STROKEAHA.120.029503. View