Learning objectives
Recognising a posterior circulation acute ischaemic stroke - clinical evaluation and imaging features.
Importance of evaluation of both extra and intracranial arterial vessels on neuroimaging studies in case of acute ischemic stroke.
Technique and efficacy of endovascular therapy in tandem vertebrobasilar occlusions.
Background
Cerebral infarction is responsible for an estimated 6.7 million deaths per year representing a major cause of disability worldwide.
Posterior circulation ischaemic stroke is responsible for 20% of cerebral infarctions and carries a mortality rate of above 85% if untreated.
Although recent clinical trials have shifted the paradigm of acute ischaemic stroke (AIS) management towards endovascular treatment (EVT) in the anterior circulation (AC),
posterior circulation AIS remains a challenge due to its complex clinical picture,
with often non-specific symptoms,
leading to delays in diagnosis and...
Findings and procedure details
A total of five patients with CTA confirmed posterior circulation stroke and proximal vertebral artery lesion addressed our centre in the past 24 months.
Onset to presentations time was beyond 4,5 hours but less than 24 hours in all cases,
exact symptom onset time being unidentifiable in two patients having suffered a “wake-up stroke”.
IV thrombolysis was not initiated in this patient series.
All of the patients in this series were admitted with a moderate/ moderate to severe stroke,
NIHSS ranging from 6 to 19....
Conclusion
Posterior circulation acute ischaemic stroke clinical diagnosis poses a challenge to the clinician and radiologist,
raised awareness of its complex clinical picture and potential neuroimaging pitfalls lead to prompter treatment (Fig.
24).
While anterior circulation acute ischaemic stroke guidelines are well defined,
vertebrobasilar ischaemic stroke management still remains unclear.
Posterior circulation ischaemic stroke has a longer time to being diagnosed,
emphasizing the need for proper imaging studies,
including vertebral artery origins,
prevents delayed reperfusion (Fig.
25).
Although tandem vertebrobasilar occlusions benefit from great technical success...
Personal information
Dr.
Oana Harsan,
Resident in training,
Department of Radiology and Medical Imaging,
Emergency County Clinical Hospital Mures,
Targu Mures,
Romania
E-mail:
[email protected]
Dr.
Rares Cristian Filep,
Department of Interventional Radiology,
Emergency County Clinical Hospital Mures,
Targu Mures,
Romania
E-mail:
[email protected]
Representative cases courtesy of the Department of Interventional Radiology
Dr.
Lucian Marginean,
Coordinator of the Department of Interventional Radiology,
Emergency County Clinical Hospital Mures,
Targu Mures,
Romania
E-mail:
[email protected]
References
1.
Nouh A,
Remke J,
Ruland S.
Ischemic Posterior Circulation Stroke: A Review of Anatomy,
Clinical Presentations,
Diagnosis,
and Current Management.
Frontiers in Neurology.
2014; 5:30.
doi:10.3389/fneur.2014.00030.
2.
Cohen JE,
Ronen R.
Leker et al.
Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations—Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke,
Journal of Clinical Neuroscience,
Volume 34,
2016,
Pages 70-76,
ISSN 0967-5868,
https://doi.org/10.1016/j.jocn.2016.05.005.
3.
Ecker RD,
Tsujiura CA,
Baker CB et al.
Endovascular reconstruction of vertebral...