Thrombectomy for acute basilar artery occlusion by using double Merci retriever devices and bilateral temporary vertebral artery flow reversal

Technical note

Restricted access

Basilar artery occlusion is a dramatic clinical event with a high mortality rate if patients are treated by standard medical therapy, including anticoagulation agents. The use of intravenous tissue plasminogen activator or intraarterial thrombolysis recanalizes 30–53 and 64%, respectively, of patients with basilar stroke. Mechanical endovascular treatments allow tailored procedures with quicker results and higher recanalization rates. The authors describe a successful mechanical removal of an obstruction in an acute occlusion of the basilar artery tip involving both proximal segments of posterior cerebral arteries in a 20-year-old man. They used 2 Merci retriever devices at the same time, and performed bilateral proximal vertebral artery occlusion for temporary flow reversal and aspiration.

Abbreviations used in this paper: BA = basilar artery; DS = digital subtraction; PCA = posterior cerebral artery; VA = vertebral artery; VBA = vertebrobasilar artery.

Article Information

Address correspondence to: Frédéric Clarençon, M.D., Service de Neuroradiologie, Hôpital H. Mondor, 51 Avenue du Maréchal De Lattre De Tassigny, 94000 Créteil, France. email: fredclare5@msn.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Cerebral CT angiography study, maximum intensity projection reconstruction; coronal view. A defect is demonstrated in the lumen of the distal segment of the BA and in the proximal part of the P1 segment of the PCAs, corresponding to the thrombus (arrow). The P2 and distal segments of the PCAs are fed by the posterior communicating arteries. A CT angiography study is useful to plan the endovascular procedure by evaluating the extension of the thrombus and the PCA diameters.

  • View in gallery

    Preprocedural DS angiography study of the left VA; frontal view.

  • View in gallery

    Endovascular procedure; angiography study demonstrating positioning of the guiding catheters (BALT Extrusion) at the ostium of VAs (arrows). Balloons at the tips of the guiding catheters are inflated to reverse the flow and achieve aspiration in the VAs during the retrieval of the Merci devices.

  • View in gallery

    Left: Nonsubtracted angiogram after contrast injection through the 2 microcatheters, demonstrating the Merci devices at P1 segments past the thrombus (left arrow, X6 Merci device; right arrow, L6 Merci device). Right: Fluoroscopic image obtained without contrast injection, demonstrating gentle and slow retrieval of the Merci devices, one after the other.

  • View in gallery

    Angiography study demonstrating the left VA, anteroposterior view, at the end of the procedure, showing total recanalization of the BA and proximal segments of the PCAs.

  • View in gallery

    Axial MR diffusion weighted image performed 3 days after the onset of symptoms. Multiple punctiform infarcts are seen in the pons and the cerebellar hemispheres. All lesions remained asymptomatic.

References

  • 1

    Brandt Tvon Kummer RMuller-Kuppers MHacke W: Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27:8758811996

    • Search Google Scholar
    • Export Citation
  • 2

    Brekenfeld CSchroth GEl-Koussy MNedeltchev KReinert MSlotboom J: Mechanical thromboembolectomy for acute ischemic stroke: Comparison of the catch thrombectomy device and the merci retriever in vivo. Stroke 39:121312192008

    • Search Google Scholar
    • Export Citation
  • 3

    Eckert BKucinski TPfeiffer GGroden CZeumer H: Endovascular therapy of acute vertebrobasilar occlusion: Early treatment onset as the most important factor. Cerebrovasc Dis 14:42502002

    • Search Google Scholar
    • Export Citation
  • 4

    Liebig TReinartz JHannes RMiloslavski EHenkes H: Comparative in vitro study of five mechanical embolectomy systems: Effectiveness of clot removal and risk of distal embolization. Neuroradiology 50:43522008

    • Search Google Scholar
    • Export Citation
  • 5

    Lindsberg PJMattle HP: Therapy of basilar artery occlusion: A systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 37:9229282006

    • Search Google Scholar
    • Export Citation
  • 6

    Lutsep HLRymer MMNesbit GM: Vertebrobasilar revascularization rates and outcomes in the merci and multi-merci trials. J Stroke Cerebrovasc Dis 17:55572008

    • Search Google Scholar
    • Export Citation
  • 7

    Mayer TEHamann GFBrueckmann H: Mechanical extraction of a basilar-artery embolus with the use of flow reversal and a microbasket. N Engl J Med 347:7697702002

    • Search Google Scholar
    • Export Citation
  • 8

    Mayer TEHamann GFBrueckmann HJ: Treatment of basilar artery embolism with a mechanical extraction device: Necessity of flow reversal. Stroke 33:223222352002

    • Search Google Scholar
    • Export Citation
  • 9

    Saqqur MUchino KDemchuk AMMolina CAGarami ZCalleja S: Site of arterial occlusion identified by transcranial doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38:9489542007

    • Search Google Scholar
    • Export Citation
  • 10

    Smith WS: Intra-arterial thrombolytic therapy for acute basilar occlusion: Pro. Stroke 38:7017032007

  • 11

    Smith WSSung GSaver JBudzik RDuckwiler GLiebeskind DS: Mechanical thrombectomy for acute ischemic stroke: Final results of the multi merci trial. Stroke 39:120512122008

    • Search Google Scholar
    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 116 116 6
Full Text Views 110 110 0
PDF Downloads 67 67 0
EPUB Downloads 0 0 0

PubMed

Google Scholar