Trombectomía retrógrada en ictus isquémico basilar sin acceso vascular posterior / Retrograde thrombectomy in basilar ischemic ictus without posterior vascular access

RESUMEN INTRODUCCIÓN: El 10 % de los ictus afecta la circulación posterior, tiene una importante repercusión neurológica y llegan a comprometer la vida. El manejo inicial de estos pacientes incluye la trombolisis farmacológica y mecánica para reestablecer el flujo de la irrigación de estructuras vitales como el mesencéfalo y las estructuras del puente. METODOLOGÍA: Se presenta el caso de un paciente de 81 años que presentó inestabilidad de la marcha con hemianopsia izquierda. Se documentó en angiotomografía la oclusión de la arterial basilar, arterial vertebral izquierda y la estenosis crítica de arteria vertebral derecha. Debido a que la cateterización de las arterias vertebrales no era posible, se decidió acceder a la arteria basilar a través de la arteria comunicante posterior. RESULTADOS: Se realizó una adecuada revascularización de la arteria basilar, comprobada por arteriografía. Sin embargo, 12 horas después, el paciente presentó reoclusión de territorio basilar que provocó muerte cerebral. CONCLUSIÓN: Los pacientes con difícil cateterización de circulación posterior por oclusión o estenosis crítica proximal del territorio posterior, con patencia y permeabilidad del polígono de Willis, serían candidatos a este tipo de procedimiento, se deben realizar más estudios con pacientes que presenten condiciones similares para optimizar su desenlace neurológico posterior a ictus en territorio de estructuras vitales.

SUMMARY INTRODUCTION: 10% of the strokes affect the posterior circulation, with important neurological deficit and they may compromise the life. Initial management of these patients includes pharmacological thrombolysis and mechanical thrombectomy to re-establish the flow of irrigation from vital structures such as the midbrain and brainstem. METHOD: We present the case of an 81-year-old patient, with unsteady gait with left hemianopsia. Basilar and left vertebral artery occlusion were demonstrated by angiotomography, and critical right vertebral artery stenosis. Due a catheterization of the vertebral arteries was not possible, Basilar artery access through a posterior communicating artery was performed. RESULTS: Adequate revascularization of the basilar artery was performed, by angiography. However, 12 hours later, the patient presented the re-occlusion of the basilar artery that caused brain death. CONCLUSION: Patients with occlusion or severe stenosis in posterior circulation with patency and permeability of the Willis polygon would be candidates for this type of procedure. Further studies are needed to confirm the neurological outcome after stroke in the territory of vital structures with limited vascular access.

Efficacy observation of endovascular therapy and medical therapy for symptomatic intracranial artery stenosis / 中国脑血管病杂志

Objective To investigate the efficacy comparison of endovascular therapy and simple medical therapy for symptomatic intracranial artery stenosis. Methods A total of 145 patients with intracranial artery stenosis were analyzed retrospectively. They were divided into either an endovascular therapy group (n=72) or a medical therapy group (n=73). They were treated with endovascular therapy (gateway balloon,wingspan stents,Apollo stents) or medical therapy (aspirin 100 mg/d,clopidogrel 75mg/d, and atorvastatin 20-40 mg/d) according the willingness of the patients or their family members. The incidences of stroke and transient ischemic attack ( TIA ) , and restenosis rate ( stenosis rate >50% as a standard) during 1-,3-,6-,9-,and 12-month follow-up periods were observed and compared. Results On the basis of medical therapy,the patients of the endovascular therapy group were successfully stented. The success rate of stenting was 98. 6% (70/71). Seven patients had complications in the endovascular therapy group (9.9%),2 of them complicated with hemorrhage(one of was died),drinking cough,hoarseness, dizziness,headache,and excitement were one case in each, the other patients were cured and discharged with active medical treatment, and they did not have serious sequelae. At 12 months after treatment, the stroke recurrence rate of the endovascular therapy group was 8. 4% (n=6,both were TIA),and that of the medical therapy group was 26. 0% (84. 2% was minor stroke). There was significant difference (χ2 =7. 752,P0. 05). Conclusion Compared with the medical therapy,the efficacy of endovascular therapy for symptomatic intra-cranial arterial stenosis is more significant. The improvement of clinical prognosis is superior to medical therapy.