The importance of col­lateral circulation in acute basilar artery occlusion


Authors: M. Tinková 1;  P. Malý 1;  H. Parobkova 2;  O. Bradáč 1
Authors‘ workplace: Ústav klinických neurooborů, Komplexní cerebrovaskulární centrum, – neurologické a neurochirurgické, oddělení, ÚVN a VFN, Praha ;  Radiodiagnostické oddělení, ÚVN a VFN, Praha 2
Published in: Cesk Slov Neurol N 2019; 82(5): 518-525
Category: Original Paper
doi: 10.14735/amcsnn2019518

Overview

Aim: We evaluated the prognostic value of a radiological Basilar Artery on Computed Tomography Angiography (BATMAN) score in patients with acute arterial basilaris occlusion (BAO).

Methods: We retrospectively analyzed clinical and imag­­ing data of consecutive endovascular ther­apy-treated patients with BAO in our stroke unit between 2006– 2018. The dia­gnosis of BAO was made on CTA. BATMAN score is a 10-point CTA-based grad­­ing system. Good outcome was defined as a modified Rankin Scale score of 0– 3 within 3 months.

Results: We included 67 patients (37 men) with BAO treated with endovascular ther­apy (mechanical thrombectomy): mean age 63 years (range 31– 82 years), median National Institutes of Health Stroke Scale (NIHSS) 16; and interquartile range 2– 36. Succesful recanalization modified as Thrombolysis in Cerebral Infarction (TICI) 2b-3 was achieved in 91% (61/ 67) of patients. Multivariate logistic regres­sion analysis identified BATMAN score ≤ 7 (OR 27.59; 95% CI 5.78– 131.81; P = 0.001) and initial NIHSS ≥ 10 (OR 9.62; 95% CI 1.47– 63.10; P = 0.0183) as independent predictors of poor outcome.

Conclusion: The BATMAN score demonstrated its ability to predict severe disability and death after BAO despite endovascular reperfusion ther­apies.

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

The authors declare they have no potential 
conflicts of interest concerning drugs, products, or services used in the study.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

 

 

M. Tinková1, P. Malý1, 
H. Parobková2, O. Bradáč1

1 
Ústav klinických neurooborů, 
Komplexní cerebrovaskulární centrum – neurologické a neurochirurgické oddělení, ÚVN a VFN, Praha

2 
Radiodiagnostické oddělení, 
ÚVN a VFN, Praha

 

MUDr. Marie Tinková

Ústav klinických neurooborů

Komplexní cerebrovaskulární centrum

Neurologické oddělení

ÚVN a VFN

U Vojenské nemocnice 1200

169 02 Praha

e-mail: marie.tinkova@uvn.cz

 

Přijato k recenzi: 19. 7. 2019

Přijato do tisku: 21. 8. 2019

Keywords:

basilar artery occlusion – collateral circulation – endovascular therapy – BATMAN score


Sources

1. Alemseged F, Shah DG, Diomedi M et al. The basilar artey on computed tomography angiography prognostic score for basilar artery occlusion. Stroke 2017; 48(3): 631– 637. doi: 10.1161/ STROKEAHA.116.015492.

2. Alemseged F, Van der Hoeven E, Di Giul­liano F et al. Response to late-window endovascular revascularisation is as­sociated with col­lateral status in basilar artery occlusion. Stroke 2019; 50: 1415– 1422. doi: 10.1161/ STROKEAHA.118.023361.

3. Cho TH, Nighoghos­sian N, Tahon F et al. Brain stem Dif­fusion-weighted imag­­ing lesion score: a potential marker of outcome in acute basilar artery occlusion. AJNR 2009; 30(1): 194– 198. doi: 10.3174/ ajnr. A1278.

4. Goldmakher GV, Camargo EC, Furie KL et al. Hyperdense basilar artery sign on unenhanced CT pedicts thrombus ando oucome in acute posterior circulation stroke. Stroke 2009; 40(1): 134– 139. doi: 10.1161/ STROKE AHA.108.516690.

5. Kayan Y, Meyers PD, Prestigiacomo CJ et al. Cur­rent endovascular strategies for posterior circulation large ves­sel occlusion stroke: report on the Society of neurointerventional surgery standards and guidelines com­mittee. J Neurointervent Surg 2019. pii: neurintsurg-2019-014873. doi: 10.1136/ neurintsurg-2019-014873.

6. Roth C, Mileke A, Siekmann R et al. First experiences with a new device for mechanical thrombectomy in acute basilar artery occlusion. Cerebrovasc Dis 2011; 32(1): 28– 34. doi: 10.1159/ 00324948.

7. Arnold M, Nedeltchev K, Schroth G et al. Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. J Neurol Neurosurg Psych 2004; 75(6): 857– 862. doi: 10.1136/ jn­np. 2003.020479.

8. Baek JM, Yoon W, Kim SK et al. Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset. AJNR 2014; 35(5): 989– 993. doi: org/ 10.3174/ ajnr.A3813.

9. Bose A, Henkes H, Alfke K et al. The Penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR 2008; 29(7): 1409– 1413. doi: 10.3174/ ajnr.A1110.

10. Berg-Dam­mer E, Felber SR, Henkes H et al. Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis. Cerebrovasc Dis 2000; 10(3): 183– 188. doi: 10.1159/ 000016054.

11. Dumont AS, Ford GA. Delayed revascularisation in patients with basilar artery occlusion. Stroke 2019; 50(6): 1327– 1328. doi: 10.1161/ STROKEAHA.119.025499.

12. Eckert B, Koch CH, Thomal­la G et al. Aggres­sive ther­apy with intravenous abciximab and intra-arterial rtPA and additional PTA/ stent­­ing improves clinical outcome in acute vertebrobasilar occlusion. Stroke 2005; 36(6): 1160– 1165. doi: 10.1161/ 01.STR.000165918.80812.

13. Goyal N, Tsivgoulis G, Nickele C et al. Posterior circulation CT angiography col­laterals predict outcome of endovascular acute ischemic stroke ther­apy for basilar artery occlusion. J Neurointerv Surg 2016; 8(8):783– 786. doi:10.1136/ neurintsurg-2015-011883.

14. Ostrem JL, Saver JL, Alger JR et al. Acute basilar artery occlusion –  dif­fusion-perfusion MRI characterisation of tis­sue salvage in patients receiv­­ing intra-arterial stroke ther­apies. Stroke 2004; 35(2): e30– e34. doi: 10.1161/ 01.STR.0000113783.45745.BE.

15. Sairanen T, Strbian D, Soin­ne L et al. Intravenous thrombolysis of basilar artery occlusion. Stroke 2011; 42(8): 2175– 2179. doi: 10.1161/ STROKEAHA.110.605584.

16. Schulte-Altedorneburg G, Bruckmann H, Hamann GF et al. Ischemic and hemor­rhagic complications after intra-arterial fibrinolysis in vertebrobasilar occlusion. AJNR 2007; 28(2): 378– 381.

17. Puetz V, Sylaja PN, Hill MD et al. CT Angiography source images predicts final infarct extent in patients with basilar artery occlusion. AJNR 2009; 30(10): 1877– 1883. doi: 10.3174/ ajnr.A1723.

18. Yu W, Konstanian V, Fischer M: Endovascular recanalisation of basilar artery occlusion 80 days after symp­tom onset. Stroke 2007; 38(4): 1387– 1389. doi: 10.1161/ 01.STR.0000260186.93667.a2.

19. Tountopoulou A, Ahl B, Weis­senborn K et al. Intra-arterial thrombolysis us­­ing rt-PA in patients with acute stroke due to ves­sel occlusin of anterior and/ or posterior cerebral circulation. Neuroradiology 2008; 50(1): 75– 83. doi: 10.1007/ s00234-007-0306-1.

20. Dias FA, Ales­sio-Alvez FF, Castro-Alfonzo LHet al. Clinical outcomes of patients with acute basilar artery occlusion in Brazil: an observational study. J Stroke Cerebrovasc Dis 2017; 26(10): 2191– 2198. doi. org/ 10. 1016/ jstrokecerebrovascdis.

21. Mordasini P, Brekenfeld C, Byrne JV et al. Technical feasibility and application of mechanical thrombectomy with the Solitaire FR revascularisation device in acute basilar artery occlusion. AJNR 2013; 34(1): 159– 163. doi: org/ 10.3174/ ajnr.A3168.

22. Tomek A et al. Neurointenzivní péče. 3. vyd. Praha: Mladá fronta a. s. 2018.

23. Uno J, Kameda K, Otsuji R et al. Mechanical thrombectomy for acute basilar artery occlusion in early therapeutic time window. Cerebrovasc Dis 2017; 44(3– 4): 217– 224.doi: 10.1159/ 000479939.

24. Kalina M. Akutní neurologie –  intenzivní péče v neurologii. Praha: Triton 2000.

25. Sparaco M. Basilar artery occlusion: clinical management and ther­apy. Clin Management Is­sues 2018; 12(1): 67– 76. doi: 10.7175/ cmi.v12i1.1363.

26. Goldemund D, Brichta J, Vaníček J et al. Spontán­ní disekce a. basilaris jako vzácná příčina mozkového infarktu. Neurol praxi 2012; 13(5): 292– 294.

27. Mrklovský M, Klzo L, Geier P. Disekce bazilární tepny jako příčina ischemické cévní příhody. Ces Radiol 2008; 62(1): 92– 96.

28. Drábek P. Trombóza arteria basilaris imitující temporální konus. Cesk Slov Neurol N 1988; 51: 148– 150.

29. Ferbert A, Bruckmann H, Drum­men E. Clinical features of proven basilar artery occlusion. Stroke 1990; 21(8): 1135– 1142. doi: 10.1161/ 01.str.21.8.1135.

30. Bergui M, Stura G, Daniele D et al. Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. Stroke 2006; 37(1): 145– 150. doi: 10.1161/ 01.STR.0000195178.20019.dc.

31. Hankey GJ. The BASICS of treat­­ing symp­tomatic basilar artery thrombosis. Lancet Neurol 2009; 8(8): 695– 697. doi: 10.1016/ S1474-4422(09)70152-8.

32. Školoudík D, Šaňák D et al. Rekanalizační terapie akutní ischemické cévní mozkové příhody. Praha: Maxdorf 2013.

33. Škoda O. Dia­gnostika a léčba ischemických CMP ve vertebrobazilárním povodí. CMP Journal 2019; 1: 9– 15.

34. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro dia­gnostiku a léčbu pa­cientů s ischemickou cévní mozkovou příhodou. Cesk Slov Neurol N 2016; 79/ 112(3): 351– 363. doi: 10.14735/ amcsn­n2016351.

35. Liebeskind D. Col­lateral circulation. Stroke 2003; 34(9): 2279– 2284. doi: 10.1161/ 01.STR.0000086465.41263.06.

36. Volný O, Mikulík R. Kolaterální cirkulace mozku –  potencionální cíl terapie mozkových infarktů. Cesk Slov Neurol N 2013; 76/ 109(3): 307– 314.

37. Brandt T, von Kum­mer R, Mul­ler-Kuppers M et al. Thrombolytic ther­apy of acute basilar artery occlusion: variables af­fect­­ing recanalisation and outcome. Stroke 1996; 27(5): 875– 881. doi: 10.1161/ 01.STR.27.5.875.

38. Nekula J, Vlachová I, Chudoba V. Dynamika uzávěru bazilární tepny v DSA a MR obraze. Ces Radiol 1995; 49(2): 93– 96.

39. Maas MB, Lev MH, Ay H et al. Col­lateral ves­sels on CT Angiography predict outcome in acute ischemic stroke. Stroke 2009; 40(9): 3001– 3005. doi: 10.1161/ STROKEAHA.109.552513.

40. Nambiar V, Sohn SI, Almekhlafi MA et al. CTA col­lateral status and response to recanalisation in patients with acute ischemic stroke. AJNR 2014; 35(5): 884– 890. doi: 10.3174/ ajnr.A3817.

41. Souza LC, Yoo AJ, Chaudhry ZA et al. Malignant CTA col­lateral profile is highly specific for large admis­sion DWI infarct core and poor outcome in acute stroke. AJNR 2012; 33(7): 1331– 1336. doi: 10.3174/ ajnr.A2985.

42. Tan IY, Demchuk AM, Hopyan J et al. CT angiography clot burden score and col­lateral score: cor­relation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR 2009; 30(3): 525– 531. doi: 10.3174/ ajnr.A1408.

43. Vagal A, Aviv R, Sucharew H et al. Col­lateral clock is more important than time clock for tis­sue fate. Stroke 2018; 49(9): 2102– 2107. doi: 10.1161/ STROKEAHA.118.021484.

44. Bang OY, Saver JL, Kim SJ et al. Col­lateral flow predicts response to endovascular ther­apy for acute ischemic stroke. Stroke 2011; 42(3): 693– 699. doi: 10.1161/ STROKEAHA.110.595256.

45. Lau AY, Wong EH, Wong A et al. Significance of good col­lateral compensation in symp­tomatic intracranial atherosclerosis. Cerebrovasc Dis 2012; 33(6): 517– 524. doi: 10.1159/ 000337332.

46. Sal­lustio F, Motta C, Pizzuto S et al. CT angiography-based col­lateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke. J Neurointervent Surg 2017; 9(10): 940– 943. doi: org/ 10.1136/ neurintsurg-2016-012628.

47. Brun­ner F, Tomandl B, Hanken K et al. Impact of col­lateral circulation on early outcome and risk of hemor­rhagic complications after systemic thrombolysis. Int J Stroke 2014; 9(8): 992– 998. doi: 10.1111/ j.1747-4949. 2012.00922.x.

48. Shuaib A, Butcher K, Moham­mad AA et al. Col­lateral blood ves­sels in acute ischaemic stroke: a potential thera­peutic target. Lancet Neurol 2011; 10(10): 909– 921. doi: 10.1016/ S1474-4422(11)70195-8.

49. Bang OY, Saver JL, Kim SJ et al. Col­lateral flow averts hemor­rhagic transformation after endovascular ther­apy for acute ischemic stroke. Stroke 2011; 42(8): 2235– 2239. doi: 10.1161/ STROKEAHA.110.604603.

50. Angermaier A, Langner S, Kirsch M et al. CT-angiographic col­lateralisation predicts final infarct volume after intra-arterial thrombolysis for acute anterior circulation ischemic stroke. Cerebrovasc Dis 2011; 31(2): 177– 184. doi: 10.1159/ 000321868.

51. van der Hoeven EJ, McVer­ry F, Vos JA et al. BASICS Registry Investigators. Col­lateral flow predicts outcome after basilar artery occlusions: the posterior circulation col­lateral score. Int J Stroke 2016; 11(7): 768– 775. doi: 10.1177/ 1747493016641951.

52. Singer OC, Berkefeld J, Nolte CH et al. ENDOSTROKE study Group. Mechanical recanalisation in basilar artery occlusion: the ENDOSTROKE Study. Ann Neurol 2015; 77(3): 415– 424. doi: 10.1002/ ana.2436.

53. Hacke W, Kaste M. Fieschi C et al. Randomized double-blind placebo-control­led trial of thrombolytic ther­a­­py with intravenous altepase in acute ischaemic stroke (ECASS II). Lancet 1998; 352(9136): 1245– 1251.

54. Baixue J, Liebeskind DS, N­­ing M et al. Factors as­sociated with perforator stroke after selective basilar artery angioplasty or stenting. J Neurointerv Surg 2017; 9(8): 738– 742. doi: 10.1136/ neurintsurg-2016-012329.

55. Gory B, Mazighi M, Laubreuche J et al. Predictors for mortality after mechanical thrombectomy of acute basilar artery occlusion. Cerebrovasc Dis 2018; 45(1– 2): 61– 67. doi: 10.1159/ 000486690.

56. Renard D, Landragin N, Robinson A et al. MRI-Based Score for acute basilar artery thrombosis. Cerebrovasc Dis 2008; 25(6): 511– 516. doi: 10.1159/ 00013668.

57. Krajina A, Krajíčková D, Lojík M et al. Endovaskulární rekanalizace při léčbě akutních uzávěrů mozkových tepen. Ces Slov Neurol N 2010; 73/ 106(6): 678– 684.

58. Vergouwen MD, Compter A, Tan­ne D et al. Outcomes of basilar artery occlusion in patients aged 75 years or older on the Basilar Artery International Coopera­tion Study. J Neurol 2012; 259(11): 2341– 2346. doi: 10.1007/ s00415-012-6498-2.

59. Dorňák T, Herzig R, Krajina A et al. Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial. Clin Radiol 2015; 70(5): e20– e27. doi: org/ 10.1016/ j.crad.2015.01.008.

60. Jung S, Mono ML, Fischer U et al. Three-month and longterm outcomes and their predictors in acute basilar artery occlusion treated with intra-arterial thrombolysis. Stroke 2011; 42(7): 1946– 1951. doi: 10.1161/ STROKEAHA.110.606038.

61. Schonewil­le WJ, Algra A, Serena J et al. Outcome in patients with basilar artery occlusion treated conventional­ly. J Neurol Neurosurg Psychiatry 2005; 76(9): 1238– 1241. doi: 10.1136/ jn­np.049924.

62. Bouslama M, Haus­sen DC, Aghaebrahim A et al. Predictors of good outcome after endovascular ther­apy for vertebrobasilar occlusion stroke. Stroke 2017; 48(12): 3252– 3257. doi: 10.1161/ STROKEAHA.117.018270.

63. Yoon W, Kim SK, Heo TW et al. Predictors of good outcome after stent retriever thrombectomy in acute basilar artery occlusion. Stroke 2015; 46(10): 2972– 2975. doi: 10.1161/ STROKEAHA.115.010840.

64. Voetsch B, DeWitt D, Pes­sin MS et al. Basilar artery occlusive dis­ease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 2004; 61(4): 496– 504. doi: 10.1001/ archneur.61.4.496.

65. Ottomeyer C, Zel­ler J, Fesl G et al. Multimodal recanalisation ther­apy in acute basilar artery occlusion. Stroke 2012; 43(8): 2130– 2135. doi: 10.1161/ STROKEAHA.112.651281.

66. Tsao JW, Hemphill JC, Johnston C et al. Glasgow Coma Scale Score predicts outcome fol­low­­ing thrombolysis for posterior circulation stroke. Arch Neurol 2005; 62(7): 1126– 1129. doi: 10.1001/ archneur.62.7.1126.

67. Powers CJ, Dornbos D, Mlynash M et al. Thrombectomy with conscious sedation compared with general anesthesia: a DEFUSE 3 analysis. AJNR 2019; 40(6): 1001– 1005. doi: 10.3174/ ajnr.A6059.

68. Goyal N, Malhotra K, Ishfaq MF et al. Cur­rent evidence for anesthesia management dur­­ing endovascular stroke ther­apy: updated systematic review and meta-analysis. J Neurointerv Surg 2019; 11(2): 107– 113. doi: 10.1136/ neurintsurg-2018-013916.

69. Jagani M, Brinjikji W, Rabinstein AA et al. Hemodynamics dur­­ing anestesia for intra-arterial ther­apy of acute ischemic stroke. Neurointervent Surg 2016; 8(9): 883– 888. doi: 10.1136-neurintsurg-2015-011867.

70. Lowhagen Hendén P, Rentzos A, Karls­son JE et al. Hypotension dur­­ing endovascular treatment of ischemic stroke is a risk factor for poor neurological outcome. Stroke 2015; 46(9): 2678– 2680. doi: 10.1161/ STROKE AHA.115.009808.

71. Molina CA, Selim MH. General ol local anesthesia dur­­ing endovascular procedures. Stroke 2010; 41(11): 2720– 2721. doi: 10.1161/ STROKEAHA.110.595447.

72. Abou Chebl A, Lin R, Hus­sain MS et al. Conscious sedation versus general anesthesia dur­­ing endovascular ther­apy for acute anterior circulation stroke. Stroke 2010; 41(6): 1175– 1179. doi: 10.1161/ STROKEAHA.115.008761.

73. Lansberg MG, Albers GW, Wijman CA. Symp­tomatic intracerebral hemor­rhage fol­low­­ing thrombolytic ther­a­­py for acute ischemic stroke: a review of the risk factors. Cerebrovasc Dis 2007; 24(1): 1– 10. doi: 10.1159/ 000103110.

74. Liu S, Jung JH, Kim SM et al. Simultaneous bilateral carotid stent­­ing in high risk patients. AJNR 2010; 31(6): 1113– 1117. doi: 10.3174/ ajnr.A1970.

75. Liu AY, Do HM, Albers GW et al. Hyperperfusion syndrome with hemor­rhage after angioplasty for middle cerebral artery stenosis. AJNR 2001; 22(8): 1597– 1601.

76. Coutts SB, Hill MD, Sutherland G et al. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 2003; 53(5): 1053– 1060. doi: 10.1227/ 01.NEU.0000088738.80838.74.

77. Krajíčková D. Komplikace chirurgické a endovaskulární léčby onemocnění magistrálních mozkových tepen. Neurol praxi 2003; 3: 133– 136.

78. Mraček J, Choc M, Richtr P et al. Hyperperfuzní syndrom. Cesk Slov Neurol N 2005; 3: 192– 197.

79. Meinel TR, Kaesmacher J, Panos L et al. Mechanical thrombectomy for basilar artery occlusion: ef­ficacy, outcomes, and futile recanalisation in comparison with the anterior circulation. J Neurointerv Surg 2019. pii: neurintsurg-2018-014516. doi: 10.1136-neuintsurg-2018-014516.

80. Turc G, Bhogal P, Fischer U et al. European Stroke Organisation (ESO) –  European Society for minimal­ly invasive neurological ther­apy (ESMINT) guidelines on mechani­cal thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019; 11(6): 535– 538. doi:10.1136/ neurintsurg-2018-014569.

81. Powers WS, Rabinstein AA, Ackerson T et al. American Heart As­sociation Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke. Stroke 2018; 49(3): e46– e110. doi: 10.1161/ STR. 00000000000000158.

82. Becktepe JS, You SJ, Berkefeld J et al. Clinical outcome after mechanical recanalisation as mono- or adjunctive ther­apy in acute stroke: importance of time to recanalisation. Cerebrovasc Dis 2011; 32(3): 211– 218. doi: 10.1159/ 00328814.

83. Hus­sein HM, Georgiadis AL, Vazquez G et al. Occurence and predictors of futile recanalisation fol­low­­ing endovascular treatment among patients with acute ischemic stroke: a multicenter study. AJNR 2010; 31(3): 454– 458. doi 10.3174/ ajnr.A2006.

84. Molina CA. Futile recanalisation in mechanical embolectomy trials. A call to improve selection of patients for revascularisation. Stroke 2010; 41(5): 842– 843. doi: 10.1161/ STROKEAHA.110.580266.

85. Nagel S, Herweh CH, Kohrmann M et al. MRI in patients with acute basilar artery occlusion-DWI lesion scor­­ing is and independent predictor of outcome. Int J Stroke 2012; 7(4): 282– 288. doi/ 10.1111/ ijs.2012.7.is­sue-4/ is­suetoc.

86. Nie X, Pu Y, Zhang Z et al. Futile recanalisation after endo­vascular ther­apy in acute ischemic stroke. Biomed Res Int 2018; 2018: 5879548. doi: 10.1155/ 2018/ 5879548.

87. Mourand I, Machi P, Nogué E et al. Dif­fusion--weighted imag­­ing score of the brainstem: a predictor of outcome in acute basilar artery occlusion treated with Solitaire FR Device. AJNR 2014; 35(6): 1117– 1123. doi: 10.3174/ ajnr.A3870.

88. Noufal M, Schmidley JW, Erdem E et al. Basilar artery occlusion treated with mechanical thrombectomy beyond eight hours with succesful recanalisation and good functional outcomes. Cerebrovasc Dis 2009; 27(6): 614– 615. doi: 10.1159/ 000218072.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2019 Issue 5

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account