ABSTRACT
Occlusion of the basilar artery (BAO) is a rare cause of stroke, making up approximately 1% of all cases. Ischemic stroke within the basilar artery is associated with serious complications and high mortality (75-91%). BAO may occur initially in the form of mild prodromal symptoms with neurological disorders, the consequences of which can lead to death. For these reasons, BAO requires rapid diagnosis and treatment. We report the case of a 26-year-old man who suffered basilar artery occlusion and was treated with endovascular therapy. The patient was disqualified from intra-venous thrombolysis and endovascular treatment due to exceeding the therapeutic time window. Despite this, due to the location of ischemia and age of the patient, it was decided to proceed with a mechanical thrombectomy (TM). Vessel patency was restored using the Solitaire FR stent. Treatment continued with antiplatelet therapy. Despite a significant overshoot of the time window the procedure was successful and complete recanalization was achieved. During hospitalization, significant neurological symptom reductions were observed. There is no accurate data on which method of treatment of ischemic stroke is best for BAO. Expectations about the effectiveness of endovascular techniques are high.
Subject(s)
Mechanical Thrombolysis , Vertebrobasilar Insufficiency/surgery , Aerospace Medicine , Combined Modality Therapy , Contraindications , Cranial Nerve Diseases/etiology , Disease Susceptibility , Dysarthria/etiology , Epilepsy/complications , Humans , Hyperlipoproteinemia Type II/complications , Hypertension/complications , Magnetic Resonance Angiography , Male , Neuroimaging , Platelet Aggregation Inhibitors/therapeutic use , Quadriplegia/etiology , Stents , Tomography, X-Ray Computed , Vertebrobasilar Insufficiency/diagnostic imaging , Vertebrobasilar Insufficiency/drug therapy , Vertebrobasilar Insufficiency/etiology , Vertebrobasilar Insufficiency/pathology , Young AdultABSTRACT
OBJECTIVE: Presentation of the own experience in the treatment of ischemic stroke using endovascular methods of simultaneous evaluation of their effectiveness and safety. MATERIALS AND METHODS: The retrospective study involved a group of 18 patients hospitalized in 2005-2012 who were treated with intraarterial thrombolysis and mechanical thrombectomy. Overall there were 24 procedures performed. The investigated group consisted of seven (38.89%) women and 11 (61.11%) men. The average age of the patients was 60 years (SD ± 17, median - 60 years). RESULTS: In 62.50% of cases (n=15) the effect of revascularization has been achieved and another 12.50% of cases (n=3) recanalization was achieved only partially. Only in 25% of procedures (n=6) failed to achieve recanalization of the artery (TICI ≤ 1). The highest percentage of recanalized arteries were obtained by following the procedure of thrombolysis targeted - 69.24% (TICI ≥ 2b). In the case of mechanical thrombectomy total patency (TICI ≥ 2b) was 54.55%. The average duration of treatment (operation) is 157 min. After 30 days successful result of the neurological status was achieved in 57.14% of patients (n=8). Full return to independent functioning as defined within 3 months after the surgery (mRS ≤ 2) reached 57.14% of patients (n=8). CONCLUSION: Studies suggest that endovascular techniques are effective and safe in the treatment of ischemic stroke. Greater efficiency is characterized by intraarterial thrombolysis. Patients who were treated endovascular improved significantly.
