title: Treatment of acute vertebrobasilar occlusion using thrombectomy with stent retrievers: initial experience with 18 patients.
abstract: OBJECTIVE
  Acute vertebrobasilar occlusion is an ominous disease with few proved effective treatments. Experience with stent retrievers is scarce and limited to combined therapies (stent retrievers associated with previous intravenous fibrinolysis, intra-arterial thrombolysis, or other mechanical devices). We present our experience with 18 patients treated with direct thrombectomy by using stent retrievers.
  
  
  METHODS
  Eighteen patients with vertebrobasilar occlusion were treated with direct thrombectomy by using stent retrievers at our hospital. The mean age was 67.5 years. Clinical presentation was sudden deterioration in consciousness level in 61.2% and progressive or fluctuating brain stem symptoms in 38.8%. Stroke subtype (TOAST) was atherothrombotic (33.3%), undetermined (33.3%), cardioembolic (27.7%), and of unusual etiology (5.5%).
  
  
  RESULTS
  The occlusion site was the vertebral artery in 1 case, proximal basilar artery in 4, middle basilar artery in 6, distal basilar artery in 5, and unilateral posterior cerebral artery in 2 cases. SRs included the Solitaire AB in 8 cases, Solitaire FR in 5 cases, and Trevo Pro in 5 cases. An 8F Merci balloon guide catheter was used in 15 patients, and a Neuron 6F, in 3 patients. Post-clot retrieval definitive intracranial stents were used in 5 patients (27.7%). Postprocedural TICI ≥ 2b was achieved in 17 patients (94.4%). Clinically, 72.2% of patients experienced an improved NIHSS score at discharge, 22.2% died, and in 5.5% the NIHSS scores did not change. The mRS score at 3 months was 0-2 in 9 patients (50%) and 3-5 in 5 patients (27.7%).
  
  
  CONCLUSIONS
  Thrombectomy with stent retrievers is feasible in the treatment of vertebrobasilar occlusion. These initial results must be confirmed by further prospective studies with a larger number of cases.
authors.affiliation: Department of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. mm.espinosa@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Espinosa de Rueda
authors.forename: G
authors.initials: G
authors.lastname: Parrilla
authors.forename: J
authors.initials: J
authors.lastname: Zamarro
authors.forename: B
authors.initials: B
authors.lastname: García-Villalba
authors.forename: F
authors.initials: F
authors.lastname: Hernández
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D000208:Acute Disease; D000368:Aged; D001807:Blood Vessel Prosthesis; D020878:Device Removal / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D015607:Stents; D017131:Thrombectomy / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*