Ces radiol. 2014, 68(2):107-112

Endovascular treatment of ischemic stroke in vertebrobasilar territoryOriginal article

Martin Köcher1, Tomáš Dorňák2, Daniel Šaňák2, Marie Černá1, Stanislav Buřval1, Vojtěch Prášil1, Tomáš Veverka2, Michal Král2, Jana Zapletalová3
1 Radiologická klinika LF a FN, Olomouc
2 Neurologická klinika LF a FN, Olomouc
3 Ústav lékařské biofyziky LF UP, Olomouc

Aim: Occlusion of basilar artery (BAO) is a relatively rare cause of an acute ischemic stroke (AIS) with the incidence of 5-6%, however it is associated with a high mortality up to 90% if no treatment is used. The aim of our retrospective study was to assess the safety and efficacy of combined revascularization therapy including initial intravenous thrombolysis (IVT) followed directly by a mechanical thrombectomy and compare the results with IVT alone and with combined thrombolysis (IVT + intraarterial thrombolysis, IAT) in patients with AIS in vertebrobasilar territory.

Methods: Study set consisted of consecutive AIS patients with BAO, who were treated with standard IVT and following direct mechanical trombectomy using a stent retriever without waiting for any clinical or radiological improving during IVT. The results were compared with historical controls treated with IVT alone or with combined IVT + IAT. Recanalization was scored using TICI scale and clinical outcome using mRS scale; good outcome was score as 0-3.

Results: In total, 7 patients were treated with combination of IVT and stent retriever. Recanalization was achieved in 7 (100%) patients and good 3-month clinical outcome was in 5 (71%) patients. These patients had higher recanalization rate and better outcome than patients treated with IVT alone or with IVT + IAT (p = 0,142, p = 0,029). Thus, apparent trend for better clinical outcome was observed in a group of patients treated with intravenous thrombolysis with a subsequent mechanical thrombectomy.

Conclusion: Combined revascularization using IVT and stent retriever seems to be safe and effective treatment for AIS patients with BAO. It is evident that this method of treatment has a clear tendency for the best results. For the definitive evaluation, a larger group of patients is needed.

Keywords: basilar artery, acute ischemic stroke, mechanical thrombectomy, Solitaire Stent retrieval, thrombolysis

Accepted: April 15, 2014; Published: June 1, 2014  Show citation

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Köcher M, Dorňák T, Šaňák D, Černá M, Buřval S, Prášil V, et al.. Endovascular treatment of ischemic stroke in vertebrobasilar territory. Ces radiol. 2014;68(2):107-112.
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