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Single-center experience of endovascular treatment for patients with progressive posterior circulation cerebral infarction exceeding 24 h Cover

Single-center experience of endovascular treatment for patients with progressive posterior circulation cerebral infarction exceeding 24 h

Asian Biomedicine
Volume 17 (2023): Issue 2 (April 2023)
By: Guangfeng Zhao,  Xiongjun He,  Yajie Liu,  Liang Zhang and  Kaifeng Li  
Open Access
|Sep 2023

Figures & Tables

Figure 1.

A typical case who underwent emergency stent implantation after thrombectomy. (A, B). Skull MR showed subacute cerebral infarction in the right cerebellar hemisphere, cerebellar tonsil, and cerebellar vermis; (C). Angiography showed occlusion of the V2 segment of the right vertebral artery far away; (D). Thrombectomy was performed twice using an Aperio thrombectomy stent. The blood flow of the right vertebral artery was restored to an mTICI score of grade 3 after the dark red thrombus was aspirated; (E). When the guiding catheter was retracted to the right subclavian artery, angiography revealed blood vessel dissection in the V2 segment of the vertebral artery and severe stenosis in the local lumen of the V3 segment; (F). One SD stent (5*19 mm, Boston Science) was implanted in the dissection site of the V2 segment of the right vertebral artery, and 1 SD stent (4*19 mm, Boston Science) was implanted in the V3 segment of the right vertebral artery. The stent completely covered the vascular dissection with satisfactory angioplasty and an mTICI score of grade 3 of forward blood flow, without residual stenosis of the lumen; (G, H). Follow-up angiography after 3 months showed no stenosis in the stents, and the intracranial blood supply was good. mTICI, modified thrombolysis in cerebral infarction; SD, standard deviation.
A typical case who underwent emergency stent implantation after thrombectomy. (A, B). Skull MR showed subacute cerebral infarction in the right cerebellar hemisphere, cerebellar tonsil, and cerebellar vermis; (C). Angiography showed occlusion of the V2 segment of the right vertebral artery far away; (D). Thrombectomy was performed twice using an Aperio thrombectomy stent. The blood flow of the right vertebral artery was restored to an mTICI score of grade 3 after the dark red thrombus was aspirated; (E). When the guiding catheter was retracted to the right subclavian artery, angiography revealed blood vessel dissection in the V2 segment of the vertebral artery and severe stenosis in the local lumen of the V3 segment; (F). One SD stent (5*19 mm, Boston Science) was implanted in the dissection site of the V2 segment of the right vertebral artery, and 1 SD stent (4*19 mm, Boston Science) was implanted in the V3 segment of the right vertebral artery. The stent completely covered the vascular dissection with satisfactory angioplasty and an mTICI score of grade 3 of forward blood flow, without residual stenosis of the lumen; (G, H). Follow-up angiography after 3 months showed no stenosis in the stents, and the intracranial blood supply was good. mTICI, modified thrombolysis in cerebral infarction; SD, standard deviation.

Operation and clinical prognosis

Treatment and prognosisN (%)
Operation
  Balloon predilution17 (94.4)
  Thrombus extraction (Solitaire AB, Trevo, Aperio)9 (50.0)
Released stents
  Solitaire AB5 (26.3)
  Winspan8 (42.1)
  Apollo3 (15.8)
  SD3 (15.8)
Successful recanalization
  Complete recanalization (mTICI, 3)14 (77.8)
  Part recanalization (mTICI, 2b)4 (22.2)
Clinical symptoms
  Clinical symptom improvement15 (83.3)
  Invalid1 (5.6)
  Aggravation or death2 (11.1)

Characteristics of patients with posterior circulation ischemic stroke

CharacteristicsN (%)
Age (y) (mean ± SD)60.3 ±13.5
Gender
  Male12 (66.7)
  Female6 (33.3)
Vascular risk factors
  Yes16 (88.9)
  No2 (11.1)
Hypertension14 (77.8)
Diabetes mellitus6 (33.3)
Dyslipidaemia5 (27.8)
History of stroke3 (16.7)
Coronary atherosclerotic cardiomyopathy2 (11.1)
Atrial fibrillation2 (11.1)
Smoking5 (27.8)
Clinical characteristics
Collateral flow
  Yes13 (72.2)
  No5 (27.8)
Stroke subtype (TOAST)
  Large-artery atherosclerosis14 (77.7)
  Cardioembolism1 (5.6)
  Stroke of undetermined etiology1 (5.6)
  Stroke of other determined etiology: Dissection2 (11.1)
Occlusion site
  Basilar or Basilar and Vertebral artery11 (61.1)
  Vertebral artery7 (38.9)
Baseline NIHSS (median, IQR)10, 4.5–12
Day 90 mRS (median, IQR)1.3, 2.3
Time from onset to puncture (median, IQR)116.5, 48–205.75
Day 90 NIHSS (median, IQR)4.6, 8

Univariate analysis of clinical, radiological, and procedural variables affecting functional outcome 90 days after stroke

CharacteristicsmRS score ≤2mRS score >2P
Mean age (years)57.7 ± 15.461.5 ± 3.30.5640
Gender, male/female9/32/20.3502
Clinical characteristics
  Baseline NIHSS (median, IQR)7.5, 4–10.513, 10–15.50.1040
  Time from onset to puncture104, 58.3–288.8132.5, 36.5–146.50.7159
  Collateralization, yes/no9/33/11.0000
Stroke subtype (TOAST)
  Atherothrombosis94
  Embolic10
  Dissection201.0000
Occlusion site
  Basilar artery or basilar and vertebral artery54
  Vertebral artery700.0884
DOI: https://doi.org/10.2478/abm-2023-0046 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
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Language: English
Page range: 64 - 71
Published on: Sep 17, 2023
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services
Publication frequency: 6 issues per year
Keywords:
endovascular treatment,
posterior circulation,
progressive cerebral infarction
Related subjects:
Medicine,
Assistive professions, nursing,
Basic medical science,
Basic medical science, other,
Clinical medicine,
Clinical medicine, other

© 2023 Guangfeng Zhao, Xiongjun He, Yajie Liu, Liang Zhang, Kaifeng Li, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

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