1,518 results match your criteria vertebrobasilar occlusion


Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review).

Exp Ther Med 2021 Sep 6;22(3):954. Epub 2021 Jul 6.

Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania.

Acute ischemic stroke treatment has been revolutionized by the addition of mechanical and aspiration thrombectomy. Randomized controlled trials have proven beyond doubt, the substantial clinical impact of endovascular interventions in anterior circulation territory strokes. Unfortunately, patients with vertebrobasilar ischemic stroke could not be included in these early trials due to inherent clinical, radiological, and prognostic particularities of posterior circulation ischemia; thus, indications for the treatment of posterior fossa strokes and basilar artery occlusion (BAO) are mainly based on retrospective studies and registries. Read More

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September 2021

Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects.

Front Neurol 2021 9;12:679134. Epub 2021 Jul 9.

Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.

Intracranial fusiform and circumferential aneurysms (IFCAs), especially those located on the main trunk, are uncommon and difficult to manage. Currently, literature focused on IFCAs on the main trunk of cerebral arteries is lacking. The treatment of IFCAs is still under debate. Read More

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[Collateral circulation pathway in patients with basilar artery occlusion/severe stenosis: a single-center case series].

Zhonghua Nei Ke Za Zhi 2021 Aug;60(8):734-738

Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.

To investigate the collateral circulation compensation model in patients with favorable prognosis of basilar artery occlusion/severe stenosis treated with drugs or endovascular therapy. Clinical data of patients with basilar artery occlusion/severe stenosis and good clinical outcome were retrospectively collected in the Department of Neurology, Sixth Medical Center of PLA General Hospital from January 2019 to January 2020. They were divided into intensive drug therapy group and combined endovascular therapy group. Read More

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Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage-A Retrospective Study From Four Neurovascular Centers.

Front Neurol 2021 1;12:700164. Epub 2021 Jul 1.

Department of Neuroradiology, Radiology and Policlinic of Radiology, University Hospital Halle (Saale), Halle, Germany.

Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). Read More

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Staged Endovascular Treatment for Symptomatic Occlusion Originating From the Intracranial Vertebral Arteries in the Early Non-acute Stage.

Front Neurol 2021 16;12:673367. Epub 2021 Jun 16.

Department of Neurosurgery, Peking University First Hospital, Beijing, China.

The ideal treatment for patients who survive from acute vertebrobasilar artery occlusion but develop aggressive ischemic events despite maximal medical therapy in the early non-acute stage is unknown. This paper reports the technical feasibility and outcome of staged endovascular treatment in a series of such patients with symptomatic intracranial vertebral artery occlusion. Ten consecutive patients who presented with aggressive ischemic events in the early non-acute stage of intracranial vertebral artery occlusion from Jan 2015 to Nov 2020 were retrospectively reviewed. Read More

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Atlanto-Occipital Decompression of Vertebral Artery for a Variant of Bow Hunter's Syndrome: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Jun 30. Epub 2021 Jun 30.

Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Rotational vertebral artery (VA) occlusion syndrome, also known as bow hunter's syndrome, is an uncommon variant of vertebrobasilar insufficiency typically occurring with head rotation.1-3 The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50. Read More

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Embolic stroke induced by rotational persistent 1st intersegmental artery compression.

Br J Neurosurg 2021 Jun 26:1-4. Epub 2021 Jun 26.

Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan.

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. Read More

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Interobserver Agreement in Scoring Angiographic Results of Basilar Artery Occlusion Stroke Therapy.

AJNR Am J Neuroradiol 2021 Jun 11. Epub 2021 Jun 11.

Department of Interventional Neuroradiology (Francis Turjman), Hospices Civils de Lyon, Lyon,France.

Background And Purpose: The modified TICI Infarction grading system is a metric currently used to evaluate angiographic results of thrombectomy for large-vessel occlusion in ischemic stroke. Originally designed for evaluating MCA territories, it is currently used for other vessel occlusions, including the posterior circulation. We postulate that the modified TICI use for the posterior circulation is not accurate due to the different vascular territories supplied by vertebrobasilar vasculature, making grading more complex. Read More

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Predictors of mortality for acute vertebrobasilar artery occlusion receiving endovascular treatment.

Acta Neurol Scand 2021 Jun 8. Epub 2021 Jun 8.

Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.

Objectives: Acute vertebrobasilar artery occlusion (VBAO) is a devastating type of stroke with a high mortality rate. This study aimed to investigate the predictors of 3-month and 1-year mortality in VBAO patients receiving endovascular treatment (EVT).

Materials & Methods: Consecutive acute VBAO patients undergoing EVT between January 2014 and December 2019 were retrospectively analyzed in a prospectively maintained database. Read More

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Impact of revascularization therapies on outcome of posterior circulation ischemic stroke: The Indo-US stroke project.

J Neurol Sci 2021 Aug 18;427:117499. Epub 2021 May 18.

Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston, USA.

Introduction: Posterior circulation strokes (PCS) have been less extensively studied than anterior circulation strokes (ACS), especially regarding revascularization therapies. We analyzed the differences in baseline stroke characteristics, revascularization therapy and 3-month outcomes between PCS and ACS in a large prospective multicentre Indian stroke registry.

Methods: Patients with acute ischemic stroke recruited in the Indo-US collaborative stroke project from January 2012 to August 2014 were classified into PCS and ACS based on imaging-confirmed infarct location. Read More

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Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion.

N Engl J Med 2021 05;384(20):1910-1920

From the Departments of Radiology (L.C.M.L., E.J.R.J.H., J.-A.V.) and Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Departments of Neurology (D.W.J.D.) and Radiology and Nuclear Medicine (A.L., P.-J.D.), Erasmus University Medical Center, Rotterdam, the Departments of Radiology (R.T.H.L.) and Neurology (L.J.K.) and the Department of Neurology and Neurosurgery, Brain Center, and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, and Utrecht University (A.A.), Utrecht, the Departments of Neurology (J.B.) and Radiology (G.J.L.N.), Haaglanden Medical Center, and the Department of Neurology, Haga Hospital (K.F.L.), The Hague, the Departments of Neurology (J.S.) and Radiology and Nuclear Medicine (W.H.Z.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Departments of Neurology (P.J.N.) and Radiology (C.B.L.M.M., B.J.E.), Amsterdam University Medical Center, Amsterdam, the Department of Neurology, Rijnstate Hospital, Arnhem, and the Department of Clinical Neurophysiology, University of Twente, Enschede (J.H.), the Departments of Neurology (M.J.H.W.) and Radiology (A.C.G.M.E.), Leiden University Medical Center, Leiden, and the Department of Neurology, Amphia Hospital, Breda (M.J.M.R.) - all in the Netherlands; the Interventional Neuroradiology Service (F.J.A.M.) and the Neurology Service (J.J.F.C., F.O.L.), Hospital Geral de Fortaleza, Fortaleza, the Department of Neurology, Federal University of Rio Grande do Sul and Hospital de Clinicas de Porto Alegre, Porto Alegre (S.O.M.), and the Stroke Service, Neurology Division, Department of Neuroscience and Behavioral Sciences (F.A.D., O.M.P.-N.), and the Interventional Neuroradiology Service, Department of Medical Imaging, Hematology and Oncology (D.G.A.), Ribeirão Preto Medical School, University of São Paulo, São Paulo - all in Brazil; the Institute of Neuroradiology (J.C.G.) and the Department of Neurology (V.P.), Dresden Neurovascular Center, University Hospital Carl Gustav Carus, and Medizinische Fakultät Carl Gustav Carus (H.S.), Technische Universität Dresden, Dresden, the Department of Neurology and Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin (C.H.N., H.J.A.), the Department of Neurology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim (K.S.), the Department of Neurology, University Hospital Augsburg, Augsburg (H.S.), and the Department of Neurology, Oberschwabenklinik, Ravensburg (C.M.R.) - all in Germany; Rothschild Foundation Hospital, INSERM Unité 1148, University of Paris, Paris (M.M., M.P.); the IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna (A.Z.), and the Neuroradiology Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena (S.V.) - both in Italy; the Texas Stroke Institute, Fort Worth (A.J.Y.); and the Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland (P.M.).

Background: The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied.

Methods: We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. Read More

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The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study.

Ann Palliat Med 2021 Apr;10(4):4697-4704

Department of Neurology, Taixing People's Hospital, Taixing, China.

Background: The mortality of acute ischemic stroke patients caused by vertebrobasilar artery occlusion (VBAO) is high and mechanical thrombectomy has gradually become a promising treatment for acute ischemic stroke. This study analyzed the efficacy of mechanical thrombectomy and the risk factors associated with poor outcomes in VBAO patients caused by severe local atherosclerotic stenosis.

Methods: This retrospective study enrolled patients with acute ischemic stroke caused by VBAO between March 1, 2016 and August 31, 2019. Read More

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Ipsilateral hypoperfusion caused by intracerebral steal phenomenon after carotid artery stenting: a case report.

BMC Neurol 2021 May 8;21(1):188. Epub 2021 May 8.

Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 Zhongshan East Road, Jiangsu Province, 210002, Nanjing, People's Republic of China.

Background: Abnormal hypoperfusion on the surgical side after carotid artery stenting is rare. Neurological deterioration caused by it is deceptive, which can easily lead to misdiagnosis. The mechanism of hypoperfusion has rarely been demonstrated. Read More

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A Pre-Interventional Scale to Predict Atherosclerotic Thrombosis in Acute Vertebrobasilar Artery Occlusion Patients.

Front Neurol 2021 7;12:648081. Epub 2021 Apr 7.

Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.

Determining the occlusion mechanism before endovascular treatment (EVT) is of great significance for acute large vessel occlusion patients. We aimed to develop and validate a simple pre-EVT scale with readily available variables for predicting atherosclerotic thrombosis (ISAT) in acute vertebrobasilar artery occlusion (VBAO) patients. Consecutive patients were retrieved from Nanjing Stroke Registry Program between January 2014 and December 2019 as a derivation cohort. Read More

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Relationship of brainstem infarction to rupture of nonsaccular vertebrobasilar aneurysms.

J Neurosurg 2021 Apr 23:1-7. Epub 2021 Apr 23.

Departments of1Neurosurgery.

Objective: Symptomatic nonsaccular vertebrobasilar aneurysms (NSVBAs) are associated with high rates of aneurysm-related death. Anecdotal evidence suggests that brainstem infarction may be a harbinger of aneurysm rupture. The authors aimed to investigate the association between brainstem infarction and subsequent NSVBA rupture. Read More

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Fusion for subaxial bow hunter's syndrome results in remote osseous remodeling of the hyperostotic growth responsible for vertebral artery compression.

Surg Neurol Int 2021 17;12:104. Epub 2021 Mar 17.

Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, United States.

Background: The authors present a previously unreported case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) who developed bow hunter's syndrome (BHS) or positional vertebrobasilar insufficiency. In addition, the authors demonstrate angiographic evidence of remote osseous remodeling after segmental fusion without direct decompression of the offending bony growth. BHS is a rare, yet well established, cause of posterior circulation ischemia and ischemic stroke. Read More

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General anesthesia versus monitored anesthesia care during endovascular therapy for vertebrobasilar stroke.

Am J Transl Res 2021 15;13(3):1558-1567. Epub 2021 Mar 15.

The First Clinical College of Southern Medical University Guangzhou, Guangdong Province, China.

Objective: The objective is to compare the effect of general anesthesia (GA) and monitored anesthesia care (MAC) on clinical outcomes in patients with endovascular therapy for vertebrobasilar occlusion stroke.

Methods: 139 patients undergoing endovascular therapy for vertebrobasilar stroke, were recruited. The patients were randomized into GA group and MAC group (about 1:1 ratio). Read More

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Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report.

Neurospine 2021 Mar 31;18(1):245-249. Epub 2021 Mar 31.

Department of Imaging Services and Interventional Radiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India.

Anterior surgical approaches to the cervical spinal pathology have become a frequently used technique. Anterior cervical spine surgeries are generally considered to be safe with low incidence of neurological complications. Vertebral artery (VA) injuries are infrequent during an anterior cervical spine approach but can be devastating. Read More

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Endovascular treatment of acute basilar artery occlusion: Outcomes, influencing factors and imaging characteristics from the Tama-REgistry of acute thrombectomy (TREAT) study.

J Clin Neurosci 2021 Apr 8;86:184-189. Epub 2021 Feb 8.

Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.

Objective: The effectiveness of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) remains unknown. We evaluated the feasibility, safety, and efficacy of endovascular treatment for ABAO.

Methods: We retrospectively investigated patients with ABAO who underwent MT using modern stent retrievers and an aspiration device between January 2015 and March 2019 at 12 comprehensive stroke centers. Read More

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A novel angiographic classification for the endovascular recanalization of symptomatic nonacute extracranial vertebral artery occlusion.

J Neurointerv Surg 2021 Mar 15. Epub 2021 Mar 15.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.

Background: There remains major uncertainty regarding the optimal therapy for symptomatic nonacute extracranial vertebral artery occlusion (EVAO). Endovascular recanalization for EVAO is technically challenging, and limited data are available. This research aimed to report a multicenter clinical experience of endovascular recanalization for symptomatic nonacute EVAO and establish a novel angiographic classification. Read More

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Far-Lateral Transcondylar Approach to a Right Cervicomedullary Dural Arteriovenous Fistula of the Posterior Fossa.

J Neurol Surg B Skull Base 2021 Feb 5;82(Suppl 1):S43-S44. Epub 2020 Nov 5.

Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States.

 Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are uncommon and often accompanied by subarachnoid hemorrhage (SAH). We aim to illustrate in detail the microsurgical procedure for treating a DAVF located at the cervicomedullary junction.  We present a two-dimensional operative video that includes clinical history, preoperative imaging, surgical strategy, still images with labels, clinical course, and postoperative imaging. Read More

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February 2021

Endovascular recanalization for non-acute basilar artery occlusions with progressive or recurrent ischemic symptoms: a multicenter clinical experience.

J Neurointerv Surg 2021 Mar 4. Epub 2021 Mar 4.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: There is no consensus on the optimal treatment of non-acute basilar artery occlusion (BAO), and endovascular recanalization still poses a therapeutic challenge for these patients. We report a multicenter clinical experience of endovascular recanalization for symptomatic non-acute BAO and propose an angiographic grouping to determine which patient subgroup most benefits from this treatment.

Methods: Forty-two patients with non-acute BAO with progressive or recurrent vertebrobasilar ischemic symptoms who underwent endovascular recanalization were retrospectively analyzed from January 2015 to December 2019. Read More

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Posterior Circulation Endovascular Thrombectomy for Large-Vessel Occlusion: Predictors of Favorable Clinical Outcome and Analysis of First-Pass Effect.

AJNR Am J Neuroradiol 2021 05 4;42(5):896-903. Epub 2021 Mar 4.

From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia.

Background And Purpose: Successful vessel recanalization in posterior circulation large-vessel occlusion is considered crucial, though the evidence of clinical usefulness, compared with the anterior circulation, is not still determined. The aim of this study was to evaluate predictors of favorable clinical outcome and to analyze the effect of first-pass thrombectomy.

Materials And Methods: A retrospective, multicenter, observational study was conducted in 10 high-volume stroke centers in Europe, including the period from January 2016 to July 2019. Read More

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Basilar artery occlusion presenting as sudden bilateral deafness: a case report.

J Med Case Rep 2021 Mar 2;15(1):111. Epub 2021 Mar 2.

Department of Neurosurgery, Tokushima Municipal Hospital, 2-34, Kitajyosanjima-cho, Tokushima, 770-0812, Japan.

Background: Most sudden-onset hearing loss is due to otolaryngologic- and very rarely to cerebrovascular disease. We report a woman with sudden bilateral sensorineural hearing loss. This case suggests that even in the absence of brainstem or cerebellar signs, magnetic resonance imaging (MRI) and MR angiography (MRA) should be performed since such studies may reveal signs of life-threatening vertebrobasilar artery occlusion. Read More

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Modified Sternocleidomastoid Sparing Approach for Vertebral Artery (V1) to Common Carotid Artery Transposition: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 05;20(6):E448

Division of Neurosurgery, University of Missouri, Columbia, Missouri, USA.

Vertebral artery (VA) V1 segment to common carotid artery (CCA) transposition is an uncommon operation with existing literature describing dissection of the sternoclavicular head of the sternocleidomastoid (SCM) muscle.1,2 We present a modified approach for transposition without cutting the SCM. Our patient is a 76-yr-old female with history of a previous cerebellar stroke. Read More

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Impact of the Perioperative Blood Pressure on Clinical Outcome after Thrombectomy in Acute Basilar Artery Occlusion.

J Stroke Cerebrovasc Dis 2021 Mar 9;30(3):105590. Epub 2021 Jan 9.

Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China. Electronic address:

Aim: Optimal blood pressure (BP) management in vertebrobasilar circulation stroke patients undergoing thrombectomy remains undetermined. We aimed to evaluate the impact of perioperative BP on clinical outcome after MT in acute basilar artery occlusion (BAO) patients.

Methods: We retrospectively analyzed all consecutive patients hospitalized with acute basilar artery occlusion administered endovascular treatment within 24 h from January 2012 to July 2018 in Beijing Tiantan Hospital. Read More

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Bow Hunter's Syndrome: A rare cause of vertebrobasilar insufficiency.

Radiol Case Rep 2021 Apr 30;16(4):867-870. Epub 2021 Jan 30.

Department of Radiology, Main Line Health, 130 S Bryn Mawr Ave, Bryn Mawr, PA 19010.

Bow Hunter's syndrome, also referred to as rotational occlusion of the vertebral artery, is caused by dynamic compression of a patient's dominant vertebral artery. We reported a case of successful clinical and imaging work up of Bow Hunter's Syndrome that occurred in a 79-year-old female patient. We discussed the clinical presentation, imaging findings, and subsequent management options of this rare syndrome. Read More

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Comparisons of Characteristics and Outcomes after Mechanical Thrombectomy for Vertebrobasilar Occlusion with Cardioembolism or Atherosclerotic Brain Infarction: Data from the Tokyo-Tama-Registry of Acute Endovascular Thrombectomy (TREAT).

World Neurosurg 2021 04 26;148:e680-e688. Epub 2021 Jan 26.

Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.

Background: Some reports suggest the efficacy of mechanical thrombectomy (MT) for acute vertebrobasilar artery (VBA) occlusion. The major causes of VBA occlusion include cardioembolism (CE) and large-artery atherosclerosis (LAA). However, the clinical characteristics of each cause remain unclear, and they might be important for decision making related to the indications and strategy of MT. Read More

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Direct ultrasound-guided puncture of vertebral artery V2 segment during mechanical thrombectomy.

BMJ Case Rep 2021 Jan 26;14(1). Epub 2021 Jan 26.

Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Roma, Lazio, Italy.

An 83-year-old man experienced left upper limb uncontrolled movements preceded by intense gasping during night rest, which progressed to unconsciousness and respiratory arrest requiring intubation. He was diagnosed with acute stroke due to distal occlusion of the basilar artery and received indication for endovascular thrombectomy. Standard endovascular approach includes percutaneous puncture of the femoral or radial arteries; however, the presence of unfavourable vascular anatomies (stenotic origin and tortuosity) did not allow catheterisation of the intracranial vessels through conventional access, and based on the consistent time lapse from onset of symptoms and deterioration of the clinical condition, a direct right vertebral artery ultrasound-guided puncture was performed. Read More

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January 2021