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

Guangfeng Zhao
Guangfeng Zhao
, 
Xiongjun He
Xiongjun He
, 
Yajie Liu
Yajie Liu
, 
Liang Zhang
Liang Zhang
 oraz 
Kaifeng Li
Kaifeng Li
   | 17 wrz 2023
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Article Category: Original article
Data publikacji: 17 wrz 2023
Zakres stron: 64 - 71
DOI: https://doi.org/10.2478/abm-2023-0046
Słowa kluczowe
© 2023 Guangfeng Zhao et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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 When the guiding catheter was retracted to the right subclavian artery, angiography revealed blood vessel dissection in the V2 segment of the vertebral artery and severe stenosis in the local lumen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 prognosis N (%)
Operation
  Balloon predilution 17 (94.4)
  Thrombus extraction (Solitaire AB, Trevo, Aperio) 9 (50.0)
Released stents
  Solitaire AB 5 (26.3)
  Winspan 8 (42.1)
  Apollo 3 (15.8)
  SD 3 (15.8)
Successful recanalization
  Complete recanalization (mTICI, 3) 14 (77.8)
  Part recanalization (mTICI, 2b) 4 (22.2)
Clinical symptoms
  Clinical symptom improvement 15 (83.3)
  Invalid 1 (5.6)
  Aggravation or death 2 (11.1)

Characteristics of patients with posterior circulation ischemic stroke

Characteristics N (%)
Age (y) (mean ± SD) 60.3 ±13.5
Gender
  Male 12 (66.7)
  Female 6 (33.3)
Vascular risk factors
  Yes 16 (88.9)
  No 2 (11.1)
Hypertension 14 (77.8)
Diabetes mellitus 6 (33.3)
Dyslipidaemia 5 (27.8)
History of stroke 3 (16.7)
Coronary atherosclerotic cardiomyopathy 2 (11.1)
Atrial fibrillation 2 (11.1)
Smoking 5 (27.8)
Clinical characteristics
Collateral flow
  Yes 13 (72.2)
  No 5 (27.8)
Stroke subtype (TOAST)
  Large-artery atherosclerosis 14 (77.7)
  Cardioembolism 1 (5.6)
  Stroke of undetermined etiology 1 (5.6)
  Stroke of other determined etiology: Dissection 2 (11.1)
Occlusion site
  Basilar or Basilar and Vertebral artery 11 (61.1)
  Vertebral artery 7 (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

Characteristics mRS score ≤2 mRS score >2 P
Mean age (years) 57.7 ± 15.4 61.5 ± 3.3 0.5640
Gender, male/female 9/3 2/2 0.3502
Clinical characteristics
  Baseline NIHSS (median, IQR) 7.5, 4–10.5 13, 10–15.5 0.1040
  Time from onset to puncture 104, 58.3–288.8 132.5, 36.5–146.5 0.7159
  Collateralization, yes/no 9/3 3/1 1.0000
Stroke subtype (TOAST)
  Atherothrombosis 9 4
  Embolic 1 0
  Dissection 2 0 1.0000
Occlusion site
  Basilar artery or basilar and vertebral artery 5 4
  Vertebral artery 7 0 0.0884
eISSN:
1875-855X
Język:
Angielski
Częstotliwość wydawania:
6 razy w roku
Dziedziny czasopisma:
Medicine, Assistive Professions, Nursing, Basic Medical Science, other, Clinical Medicine
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