J Korean Soc Radiol.  2017 Apr;76(4):287-293. 10.3348/jksr.2017.76.4.287.

Endovascular Therapy for Acute Basilar Artery Occlusion: Comparison between Patients with and without Underlying Intracranial Atherosclerotic Stenosis

• Kim GS
• Kim SK
• Baek BH
• Lee YY
• Yoon W

• KMID: 2373967
• DOI: http://doi.org/10.3348/jksr.2017.76.4.287

Abstract

PURPOSE
To compare the characteristics and outcomes of multimodal endovascular therapy (EVT) in patients with acute basilar artery occlusion (BAO) with and without underlying intracranial atherosclerotic stenosis (ICAS).
MATERIALS AND METHODS
We retrospectively analyzed the data from 50 patients with acute BAO who were treated with EVT. The baseline characteristics and outcomes of patients with and without ICAS were compared. Patients with ICAS underwent intracranial angioplasty or stenting after mechanical thrombectomy.
RESULTS
Thirty percent of the patients (15/50) had underlying ICAS at the occlusion site. On pretreatment diffusion-weighted imaging (DWI), bilateral thalamic infarction was less frequently found in patients with ICAS (0% vs. 25.7%, p = 0.03). Occlusion in the proximal segment of the basilar artery was more common in patients with ICAS (60% vs. 5.7%, p < 0.001), whereas occlusion in the distal segment of the basilar artery was more common in patients without ICAS (26.7% vs. 91.4%, p < 0.001). There were no significant differences in the rates of successful revascularization, 3-month modified Rankin Scale scores of 0-2, symptomatic hemorrhage, and mortality between the two groups.
CONCLUSION
ICAS was common in patients with acute stroke due to BAO. The occlusion site and the presence or absence of bilateral thalamic infarction on pretreatment DWI might help predict the underlying ICAS in patients with acute BAO.

MeSH Terms

Angioplasty
Basilar Artery*
Brain Infarction
Constriction, Pathologic*
Endovascular Procedures
Hemorrhage
Humans
Infarction
Intracranial Arteriosclerosis
Mechanical Thrombolysis
Mortality
Retrospective Studies
Stents
Stroke
Thrombectomy

Figure

• 

  Fig. 1. A 74-year-old patient with acute stroke due to acute basilar artery occlusion. A. DWI images show a high signal intensity lesion involving the right sided pons. There is no evidence of acute infarction in bilateral thalami. B. Left vertebral artery angiography shows an occlusion (arrow) in the proximal segment of the basilar artery. C. Angiography obtained after single passage of the stent-retriever reveals a severe underlying atherosclerotic stenosis (arrow) at the previous occlusion site. D. Left vertebral angiography obtained after intracranial angioplasty and stenting shows complete recanalization of the basilar artery with good distal perfusion. Arrows indicate the proximal and distal ends of the Wingspan stent. E. Photograph shows small fragmented thrombi retrieved with a Solitaire stent. F. Maximum-intensity-projection image of the followup CT angiography 1 week after the procedure shows good patency of the stented segment (arrows) of the basilar artery. DWI = diffusion-weighted imaging

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