Article Figures & Data
Figures
- Figure 1
Illustration of the reverse (A) and the antegrade (B) technique for the tandem vertebrobasilar artery occlusion through the occlusive or severe stenotic vertebral artery (dirty-road path). (A) A guiding catheter was advanced to the distal left vertebral artery (LVA) V2 segment through the stenosis segment over the partially reinflated balloon. A stent retriever was deployed at the segment of the basilar artery (BA). After successful recanalisation was achieved, the microguidewire was sent to the V2 segment and then the guiding catheter was gently pulled back to the proximal subclavian artery. A balloon-expandable stent was then implanted at the ostial vertebral artery. (B) A balloon-expandable stent was sent to the ostial vertebral artery over the microguidewire and was implanted at the lesion exactly. The guiding catheter was then navigated to the distal V2 segment through the partially reinflated balloon across the implanted stent gently. Subsequently, the stent-assisted thrombectomy was performed as described above.
- Figure 2
Case example 1. (A) Left vertebral artery occlusion. (B) A 6 Fr catheter crossing the left vertebral artery through the stent over the partially reinflated balloon. (C) Right non-dominant ending in posterior inferior cerebellar artery. (D) Basilar artery occlusion. (E) Recanalisation of the basilar artery. (F) Final angiography of the left vertebral artery.
- Figure 3
Case example 2. (A) Left vertebral artery occlusion. (B) Right vertebral artery ostial severe stenosis. (C) Predilation of the right vertebral artery stenosis. (D) Distal basilar artery clot. (E) Recanalisation of the basilar artery. (F) A stent-assisted angioplasty at the right vertebral artery.
Tables
- Table 1
Summary of patient clinical data
Case no Sex/age (years) NIHSS at admission Time to puncture (min) Time to recanalisation (min) Treatment strategy Occlusion Contralateral vertebral artery TICI score Haemorrhage mRS at 3 months 1 M/57 12 207 90 AT LV1+BA Non-dominant ending in PICA 3 N 0 2 M/57 28 125 105 RT LV1+BA Non-dominant ending in PICA 3 N 2 3 M/57 28 600 110 AT LV1+BA RV1 95% stenosis 3 N 6 4 M/58 16 855 77 RT LV1+BA RV1 95% stenosis 3 N 2 5 M/59 20 695 118 RT LV1+BA Non-dominant ending in PICA 2b N 4 6 M/48 25 960 175 RT RV1+BA Non-dominant (<2 mm) 3 N 6 7 M/66 25 390 194 RT LV1+BA Non-dominant ending in PICA 2b N 6 *AT/RT, antegrade technique/reverse technique; BA, basilar artery; L, left; M, male; mRS, modified Rankin Scale; N, no; NIHSS, National Institute of Health Stroke Scale; PICA, posterior inferior cerebellar artery; R, right; TICI, Thrombolysis in Cerebral Infarction; V1, first segment of the vertebral artery.
