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Título del libro: The Ischemic Stroke Casebook: Clinical And Endovascular Approaches To Revascularization
Título del capítulo: On the Edge of Shutdown: Addressing Basilar Artery Acute Ischemic Stroke in the Setting of Bilateral Chronic Internal Carotid Artery Occlusion

Autores UNAM:
MONTSERRAT ANILU LARA VELAZQUEZ;

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Autores externos:

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Idioma:

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Año de publicación:
2024

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Palabras clave:

Acute ischemic stroke; Basilar artery occlusion; Bilateral internal carotid occlusion; Collateral circulation; Endovascular therapy; Posterior circulation stroke

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Resumen:

Stroke remains the second leading cause of death worldwide and the third leading cause of death and disability combined. Posterior circulation ischemic stroke (PCS), particularly basilar artery occlusion (BAO), poses a significant challenge, with untreated cases having a mortality or severe disability rate of up to 90%. Due to its unfavorable natural history, a significant proportion of patients with acute BAO have been empirically treated with endovascular therapy (EVT) worldwide over the past two decades. However, a paradigm shift in research has occurred with the introduction of the first two positive randomized controlled trials, namely the Endovascular Treatment of Acute Basilar Artery Occlusion (ATTENTION Registry) and the Basilar Artery Occlusion Chinese Endovascular Trial (BAOCHE). This case illustrates a cerebral hemodynamically critical scenario in which acute BAO occurs in the setting of bilateral internal carotid artery (ICA) occlusion and sudden interruption of the ?stability? of the system that had been maintained by collateral circulation is suddenly interrupted. The patient is a 62-year-old male who was brought in by Emergency Medical Services (EMS) as a ?code stroke? after being unresponsive. Imaging revealed complete bilateral occlusions of the internal carotid arteries (ICAs) and right vertebral artery, with acute near-complete occlusion of the distal basilar artery (BA), good ASPECTS on plain cranial CT, and extensive penumbra on computed tomography perfusion (CTP). Urgent aspiration thrombectomy through the left vertebral artery was successfully performed, resulting in complete recanalization. Predicting outcomes and selecting patients for EVT in BAO remains remains challenging. Caution should be exercised in excluding patients who may benefit from EVT, emphasizing the need for individualized patient assessment. © Springer Nature Switzerland AG 2024.

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Entidades citadas de la UNAM:

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Fuente:


ISBN:
9783031472015
Editorial:
Springer Nature

Tipo de producto:
Book chapter

DOI:
10.1007/978-3-031-47201-5_104