Rescue Use of Endovascular Snare for Acute Basilar Artery Embolic Occlusion Resistant to Balloon Angioplasty and Fibrinolysis Therapy

Abstract

A rescue clot disruption using a basket snare is described for acute basilar artery embolic occlusion resistant to balloon angioplasty and fibrinolysis therapy. In spite of failed balloon angioplasty in conjunction with fibrinolysis, a basket-shaped snare connected to a microguide wire could be used to catch and crush the clot in the upper basilar artery. The rescue use of a snare may be effective for angioplasty-resistant acute embolic stroke.

Key words

Angioplasty - embolic stroke - fibrinolysis - snare

References

• 1 Ringer A J, Qureshi A I, Fessler R D, Guterman L R, Hopkins L N. Angioplasty of intracranial occlusion resistant to thrombolysis in acute ischemic stroke.  Neurosurgery. 2001;  48 1282-1290
• 2 Ueda T, Sakaki S, Nochide I, Kumon Y, Kohno K, Ohta S. Angioplasty after intra-arterial thrombolysis for acute occlusion of intracranial arteries.  Stroke. 1998;  29 2568-2574
• 3 Yoneyama T, Nakano S, Kawano H, Iseda T, Ikeda T, Goya T, Wakisaka S. Combined direct percutaneous transluminal angioplasty and low-dose native tissue plasminogen activator therapy for acute embolic middle cerebral artery trunk occlusion.  AJNR Am J Neuroradiol. 2002;  23 277-281
• 4 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group . Tissue plasminogen activator for acute ischemic stroke.  N Engl J Med. 1995;  333 1581-1587
• 5 Becker K J, Monsein L H, Ulatowski J, Mirski M, WilIiams M, Hanley D F. Intraarterial thrombolysis in vertebrobasilar occlusion.  AJNR Am J Neuroradiol. 1996;  17 255-262
• 6 Endo S, Kuwayama N, Hirashima Y, Akai T, Nishijima M, Takaku A. Results of urgent thrombolysis in patient with major stroke and atherothrombotic occlusion of the cervical intracranial carotid artery.  AJNR Am J Neuroradiol. 1998;  19 1169-1175
• 7 Jansen O, Kummer R von, Forsting M, Hacke W, Sartor K. Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation.  AJNR Am J Neuroradiol. 1995;  6 1977-1986
• 8 Kerber C W, Barr J D, Berger R M, Chopko B W. Snare retrieval of intracranial thrombus in patients with acute stroke.  J Vasc Interv Radiol. 2002;  13 1269-1274
• 9 Chopko B W, Kerber C, Wong W, Georgy B. Transcatheter snare removal of acute middle cerebral artery thromboembolism: technical case report.  Neurosurgery. 2000;  46 1529-1531
• 10 Qureshi A I, Siddiqui A M, Sun M F, Kim S H, Ali Z, Yahia A M, Lopes D K, Boulos A S, Ringer A J, Saad M. Guterman LR, Hopkins LN. Aggressive mechanical clot disruption and low-dose intra-arterial third-generation thrombolytic agent for ischemic stroke: a prospective study.  Neurosurgery. 2002;  51 1319-1329
• 11 Mayer T E, Hamann G F, Brueckmann H J. Treatment of basilar artery embolism with a mechanical extraction device: necessity of flow reversal.  Stroke. 2002;  33 2232-2235
• 12 Brandt T. Diagnosis and thrombolytic therapy of acute basilar artery occlusion: a review.  Clin Exp Hypertens. 2002;  24 611-622