From the Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea (S.H.B., C.J.).
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (S.H.B., B.M.K., D.J.K.).
Stroke. 2020 Jun;51(6):1883-1885. doi: 10.1161/STROKEAHA.120.029503. Epub 2020 May 14.
Background and Purpose- Tandem vertebrobasilar strokes are not well-known causes of posterior circulation stroke. The purpose of this study was to investigate the characteristics and outcome of mechanical thrombectomy in patients with tandem vertebrobasilar stroke. Methods- Acute basilar artery occlusion patients with tandem vertebral artery (VA) stenosis/occlusion who underwent mechanical thrombectomy were retrospectively analyzed. Concomitant tandem VA steno-occlusion was defined as severe stenosis/occlusion of the extracranial VA with impaired flow. Clinical/angiographic characteristics, recanalization rate, procedure time, and clinical outcome were evaluated with comparisons according to the treatment strategy. Results- Tandem vertebrobasilar occlusion was identified in 24.6% (55 of 224) of the acute basilar artery occlusion patients. Overall successful recanalization and good clinical outcome was achieved in 87.2% (48 of 55) and 30.9% (17 of 55) of the patients. There were no significant differences in procedure time, recanalization rate, and clinical outcome in comparisons of the VA access route selection or angioplasty of the tandem VA lesion. Two patients developed short-term recurrent basilar artery occlusion when angioplasty of the tandem VA lesion was not performed. Good clinical outcome was more likely with lower baseline National Institutes of Health Stroke Scale score (odds ratio, 0.87 [95% CI, 0.787-0.961]; =0.006) and short onset-to-recanalization time (odds ratio, 0.993 [95% CI, 0.987-0.999]; =0.03). Conclusions- Tandem vertebrobasilar occlusion may be a frequent pathological mechanism of posterior circulation stroke. Good outcome may be achieved by strategic choice of the access route and selective angioplasty of the tandem VA lesion.
背景与目的-串联性椎基底动脉卒中并不是后循环卒中的常见病因。本研究旨在探讨机械取栓治疗串联性椎基底动脉卒中的特点和结局。方法-回顾性分析接受机械取栓治疗的急性基底动脉闭塞患者中伴有串联性椎动脉（VA）狭窄/闭塞的病例。同时性串联 VA 狭窄-闭塞定义为颅外 VA 严重狭窄/闭塞伴血流受损。根据治疗策略进行比较，评估临床/血管造影特征、再通率、手术时间和临床结局。结果-在 224 例急性基底动脉闭塞患者中，24.6%（55 例）存在串联性椎基底动脉闭塞。87.2%（48/55）和 30.9%（17/55）的患者实现了总体性成功再通和良好的临床结局。VA 入路选择或串联性 VA 病变血管成形术比较中，手术时间、再通率和临床结局无显著差异。2 例未行串联性 VA 病变血管成形术的患者出现短期复发性基底动脉闭塞。较低的基线国立卫生研究院卒中量表评分（优势比，0.87[95%置信区间，0.787-0.961]；=0.006）和较短的发病至再通时间（优势比，0.993[95%置信区间，0.987-0.999]；=0.03）与良好的临床结局更相关。结论-串联性椎基底动脉闭塞可能是后循环卒中的常见病理机制。通过选择合适的入路和有选择性地对串联性 VA 病变进行血管成形术，可获得良好的结局。
