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  • Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion

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Ischemic Stroke
Original research
Endovascular treatment of tandem occlusions in vertebrobasilar stroke: technical aspects and outcome compared with isolated basilar artery occlusion
  1. Eike I Piechowiak1,
  2. Johannes Kaesmacher1,6,
  3. Felix Zibold1,
  4. Tomas Dobrocky1,
  5. Pascal J Mosimann1,
  6. Simon Jung2,
  7. Urs Fischer2,
  8. Marcel Arnold2,
  9. Sebastian Bellwald2,
  10. Mirjam R Heldner2,
  11. Jan Gralla1,
  12. Pasquale Mordasini1
  1. 1 University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
  2. 2 Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
  3. 6 University Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
  1. Correspondence to Dr Eike I Piechowiak, University Institute of Diagnostic and Interventional Neuroradiology Inselspital, Bern University Hospital, Bern 3010, Switzerland; Eike.piechowiak{at}insel.ch

Abstract

Background and purpose Acute basilar artery occlusion (BAO) is a devastating disease with a high rate of mortality and morbidity, and early recanalization is crucial to achieve a good prognosis. The best treatment strategy for BAO combined with a proximal stenosis (tandem occlusion) is not yet clear. Our study aimed to evaluate whether and how vertebrobasilar tandem occlusions can be treated effectively and safely compared with isolated BAO.

Materials and methods Fifty-two patients with acute vertebrobasilar occlusive stroke treated with mechanical thrombectomy were identified in a prospective database from March 2010 to September 2016. We retrospectively analysed the clinical, technical, and functional outcomes of the patients.

Results Of the 52 patients, 15 presented with a tandem occlusion, 14 with a single intracranial occlusion due to an underlying stenosis, and 23 with a single embolic BAO. Successful recanalization was achieved in all of the patients with tandem occlusions (modified Thrombolysis in Cranial Infarction 2b/3) and in 35 of 37 patients with a single BAO (with and without stenosis). A favourable outcome was achieved (modified Rankin Scale ≤2) in 8 of the 15 patients with a tandem occlusion compared with 4 of the 14 patients with a single BAO with underlying stenosis and 5 of the 23 patients with isolated embolic BAO (p=0.18).

Conclusions We suggest that endovascular treatment of vertebrobasilar tandem occlusions is safe and feasible, with a high rate of good outcome.

  • technique
  • stroke
  • artery

https://doi.org/10.1136/neurintsurg-2019-014825

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    Footnotes

    • Contributors EIP: Author of the main manuscript. TD: Correction of the manuscript, diagnostic workup, image editing. JK: Correction of the manuscript, statistical evaluation. FZ: Correction of the manuscript, involved in the treatment. PJM: Correction of the manuscript, involved in the treatment. SJ: Provided clinical data, clinical evaluation. UF: Operator of the stroke database, acute clinical evaluation. MA: Operator of the stroke database, clinical evaluation. SB: Data processing and statistical input. MRH: Data processing and statistical input. JG: Study concept. PM: Senior author; study concept.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.