Treatment and outcomes of acute intracranial vertebrobasilar artery occlusion: one institution's experience

Clinical article

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The treatment of acute intracranial vertebrobasilar artery occlusion (VBO) has been described but often with poor results. The authors of this study set out to evaluate their institution's outcomes following multimodal treatment of VBO.


They retrospectively reviewed their endovascular database for all patients treated for acute intracranial VBO between December 2004 and June 2010. Twenty-four patients were identified. Two patients were excluded from evaluation—one because of incomplete medical records and one because the etiology was basilar stenosis and not stroke. Occlusion location, hypercoagulable causes, time to endovascular treatment, time to revascularization, comorbidities, devices used, procedural anticoagulation, and outcomes were analyzed.


Among the 22 eligible study patients, the mean National Institutes of Health Stroke Scale (NIHSS) score at presentation was 15.3. The mean time from presentation to initiation of the endovascular procedure was 4.77 hours. The mean time for recanalization from the start of angiography was 1.63 hours. In 16 patients (73%), revascularization was successful (Thrombolysis in Myocardial Infarction [TIMI] score of 2 or 3). Thirteen (59%) of the 22 patients were discharged to home or a rehabilitation facility. One patient was transferred to a chronic care facility. The overall survival rate was 64%. The average NIHSS score for the 14 surviving patients at discharge was 3.9. At the follow-up (average 14.5 months, range 1–58 months), 10 patients (71%) had achieved good outcomes (modified Rankin Scale [mRS] score ≤ 2) and 4 (29%) had poor outcomes (mRS Score 3–6).


Published case series have historically shown poor outcomes and high mortality rates in association with the treatment of acute VBO, prompting surgeons to be less aggressive in the treatment of this disease than they might be otherwise. Data in this series show that the revascularization of posterior circulation occlusions is feasible and that good outcomes and lower mortality rates with newer endovascular technologies are possible, and thus more prompt and aggressive treatment of this disease may be warranted.

Abbreviations used in this paper:MERCI = Mechanical Embolus Removal in Cerebral Ischemia; mRS = modified Rankin Scale; NIHSS = National Institutes of Health Stroke Scale; PROACT = Prolyse in Acute Cerebral Thromboembolism; TIMI = Thrombolysis in Myocardial Infarction; VBO = vertebrobasilar artery occlusion.

Article Information

Address correspondence to: Elad I. Levy, M.D., University at Buffalo Neurosurgery, 3 Gates Circle, Buffalo, New York 14209. email:

Please include this information when citing this paper: published online February 3, 2012; DOI: 10.3171/2012.1.JNS11997.

© AANS, except where prohibited by US copyright law.




Archer CRHorenstein S: Basilar artery occlusion: clinical and radiological correlation. Stroke 8:3833901977


Arnold MNedeltchev KSchroth GBaumgartner RWRemonda LLoher TJ: Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. J Neurol Neurosurg Psychiatry 75:8578622004


Becker KJMonsein LHUlatowski JMirski MWilliams MHanley DF: Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR Am J Neuroradiol 17:2552621996


Berg-Dammer EFelber SRHenkes HNahser HCKühne D: Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis. Cerebrovasc Dis 10:1831882000


Brandt Tvon Kummer RMüller-Küppers MHacke W: Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27:875 8811996


Brekenfeld CSchroth GMattle HPDo DDRemonda LMordasini P: Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment. Stroke 40:8478522009


Brückmann HFerbert Adel Zoppo GJHacke WZeumer H: Acute vertebral-basilar thrombosis. Angiologic-clinical comparison and therapeutic implications. Acta Radiol Suppl 369:38421986


Chapot RHoudart ERogopoulos AMounayer CSaint-Maurice JPMerland JJ: Thromboaspiration in the basilar artery: report of two cases. AJNR Am J Neuroradiol 23:282 2842002


Cross DT IIIMoran CJAkins PTAngtuaco EEDerdeyn CPDiringer MN: Collateral circulation and outcome after basilar artery thrombolysis. AJNR Am J Neuroradiol 19:155715631998


Cross DT IIIMoran CJAkins PTAngtuaco EEDiringer MN: Relationship between clot location and outcome after basilar artery thrombolysis. AJNR Am J Neuroradiol 18:122112281997


Eckert BKoch CThomalla GKucinski TGrzyska URoether J: Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 36:116011652005


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


Egan RClark WLutsep HNesbit GBarnwell SKellogg J: Efficacy of intraarterial thrombolysis of basilar artery stroke. J Stroke Cerebrovasc Dis 8:22271999


Ezaki YTsutsumi KOnizuka MKawakubo JYagi NShibayama A: Retrospective analysis of neurological outcome after intra-arterial thrombolysis in basilar artery occlusion. Surg Neurol 60:4234302003


Furlan AHigashida RWechsler LGent MRowley HKase C: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial Prolyse in Acute Cerebral Thromboembolism. JAMA 282:2003 20111999


Hacke WKaste MBluhmki EBrozman MDávalos AGuidetti D: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:131713292008


Hacke WZeumer HFerbert ABrückmann Hdel Zoppo GJ: Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:121612221988


Kashiwagi JKiyosue HHori YOkahara MTanoue SSagara Y: Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty. Neuroradiology 52:3613702010


Levy EIMehta RGupta RHanel RAChamczuk AJFiorella D: Self-expanding stents for recanalization of acute cerebrovascular occlusions. AJNR Am J Neuroradiol 28:8168222007


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


Mathews MSSharma JSnyder KVNatarajan SKSiddiqui AHHopkins LN: Safety, effectiveness, and practicality of endovascular therapy within the first 3 hours of acute ischemic stroke onset. Neurosurgery 65:8608652009


Mocco JHanel RASharma JHauck EFSnyder KVNatarajan SK: Use of a vascular reconstruction device to salvage acute ischemic occlusions refractory to traditional endovascular recanalization methods. Clinical article. J Neurosurg 112:5575622010


Natarajan SKKarmon YSnyder KVOhta HHauck EFHopkins LN: Prospective acute ischemic stroke outcomes after endovascular therapy: a real-world experience. World Neurosurg 74:4554642010


Natarajan SKSnyder KVSiddiqui AHIonita CCHopkins LNLevy EI: Safety and effectiveness of endovascular therapy after 8 hours of acute ischemic stroke onset and wake-up strokes. Stroke 40:326932742009


National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:158115871995


Noufal MSchmidley JWErdem EKeyrouz SG: Basilar artery occlusion treated with mechanical thrombectomy beyond eight hours with successful recanalization and good functional outcomes. Cerebrovasc Dis 27:6146152009


Ringer AJQureshi AIFessler RDGuterman LRHopkins LN: Angioplasty of intracranial occlusion resistant to thrombolysis in acute ischemic stroke. Neurosurgery 48:1282 12902001


Seifert MAhlbrecht ADohmen CSpuentrup EMoeller-Hartmann W: Combined interventional stroke therapy using intracranial stent and local intraarterial thrombolysis (LIT). Neuroradiology 53:2732822011


Sliwka UMull MStelzer ADiehl RNoth J: Long-term follow-up of patients after intraarterial thrombolytic therapy of acute vertebrobasilar artery occlusion. Cerebrovasc Dis 12:2142192001


Smith WSSung GSaver JBudzik RDuckwiler GLiebeskind DS: Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39:120512122008


Versnick EJDo HMAlbers GWTong DCMarks MP: Mechanical thrombectomy for acute stroke. AJNR Am J Neuroradiol 26:8758792005


Yu YYNiu LGao LZhao ZWDeng JPQu YZ: Intraarterial thrombolysis and stent placement for acute basilar artery occlusion. J Vasc Interv Radiol 21:135913632010


Zaidat OOWolfe THussain SILynch JRGupta RDelap J: Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke 39:239223952008




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