Arterial thrombosis is a blood clot in an artery, which can be very serious because it can stop blood reaching important organs. Background performing mechanical thrombectomy mt in patients with basilar artery occlusion bao is currently not evidencebased. The current standard of care for the treatment of arterial thrombosis includes anticoagulants and three classes of antiplatelet agents aspirin, thienopyridines and. However, a fatal basilar thrombosis related only with a minor trauma, to our knowledge, has been described and published only more than a century later, in 1990. In the basilar artery occlusion endovascular intervention versus standard medical treatment best trial, we aimed to compare endovascular treatment plus standard medical therapy with standard medical therapy alone for the treatment of patients with acute ischaemic stroke due to vertebrobasilar occlusion within 8 h of estimated occlusion. Stroke or transient ischemic attacks with basilar artery. Uncommon and in most cases fatal, basilar artery thrombosis is a devstating diagnosis. Thrombosis from ancient greek thrombosis clotting is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. Basilar artery occlusion bao is one of the most devastating forms of stroke and few patients have good outcomes without recanalization.
Mechanism of arterial thrombosis in nonparallel streamlines. Jun 22, 2017 subclavian artery thrombosis is a pathological condition, in which there is blockage or obstruction of the subclavian artery due to a blood clot. Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion bao. However, the advent of highquality, reliable, and noninvasive technology eg, magnetic resonance imaging mri has made. Thrombosis is the formation of a clot blood clot in the lumen of a blood vessel. Infarction is shown in the most graphic of manners demonstrating the distribution of all branches of the basilar artery. It is formed at the junction of the pons and medulla by the convergence of the dual vertebral arteries. Learn about the symptoms of this condition and how its treated. The blockage or obstruction of the subclavian artery may also be caused due to narrowing of the artery and formation of fatty plaques resulting in subclavian artery thrombosis. Links to pubmed are also available for selected references. Acute basilar artery occlusion radiology reference. To identify factors that predict survival and good neurologic outcome in patients undergoing basilar artery thrombolysis. Welcome to the thrombosis adviser knowledge base this section aims to serve as a comprehensive reference centre, starting with the essentials of understanding thromboembolic diseases, guiding you on to the specific arterial and venous thromboembolic conditions, treatments, prevention and finally special population considerations.
Introduction arterial thrombosis is the result of sequential events involving platelet adhesion, activation and subsequent aggregation that can lead to vascular occlusion, perhaps the primary pathological complication of advanced atherosclerotic lesions. Time window for recanalization in basilar artery occlusion. Mechanical thrombectomy for basilar artery occlusion. Dec 07, 20 basilar artery thrombosis clinical meet 1. Doubts that acute coronary thrombosis causes a heart attack. In this issue of the lancet neurology, schonewille and colleagues2 report novel, contemporary, robust, and generalisable evidence about the prognosis of symptomatic basilar artery occlusion. Fortyfive patients mean age, 59 years with basilar artery embolism participated in the study.
Basilar artery thrombosis may explain as many as 27% of ischemic strokes occurring in the posterior circulation. Atherosclerosis plaques are the most common lesion found in the basilar artery system, causing vascular stenosis or occlusion. Blood clotting where it shouldnt or when you dont want it to. Vertebral artery thrombosis is a potentially lifethreatening vascular event that can occur after injury to the cervical spine, vertebral artery dissection, but also surgical intervention. In the fourth patient basilar artery occlusion and a large pontine infarct were evident by magnetic resonance imaging and angiography. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic. Guidance for the treatment of deep vein thrombosis and. Superior mesenteric artery thrombosis and partial dissection. Arterial thrombosis is generally more serious because the supply of oxygen and nutrition to an area of. Basilar artery thrombosis and occlusion causes only about 3% of ischaemic strokes1 but contributes substantially to the morbidity of patients and to the anxiety of their clinicians.
The mortality has been estimated as high as 90% without acute intervention. Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema. Acute basilar artery thrombosis is associated with a poor prognosis. However, the advent of highquality, reliable, and noninvasive technology eg, magnetic resonance imaging mri has made its diagnosis possible even in subjects with mild symptoms see the image below. In the majority of cases, atrial thrombosis is caused by atherosclerosis, a condition in which plaque builds up around the artery wall and causes the arteries to narrow or harden. A hyperdense basilar artery is a common feature on ct scans of patients presenting with an early clinical diagnosis of thrombosis. Pdf clinical features of proven basilar artery occlusion.
Vascular thrombosis article about vascular thrombosis by. According to the paperwork reduction act of 1995, no persons are required to respond to a collection of information unless it displays a valid omb control number. When the vertebral artery is occluded, symptoms arise depending on which part of the brain is affected by ischemia. In situ thrombosis of the pulmonary arteries medical student. An unusual case of the syndrome of cervical rib with. Basilar artery occlusion is a devastating but treatable form of ischaemic stroke with high morbidity and mortality rates. A traditional recanalization approach based on historical controls and pathophysiological consideration is local intraarterial thrombolysis iat in eligible patients. Arterial occlusion due to thrombosis caused by ruptured atherosclerotic plaques baba et al. An embolus reaching the basilar artery may not necessarily reach the top of the artery. Risk factors for venous and arterial thrombosis ncbi. E in a 73yearold man with proximal basilar artery occlusion, right carotid angiography shows fi lling of the posterior cerebral arteries, the distal basilar artery, and the superior cerebellar. Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood. It could be concluded that the arteries at the base of the brain are dependent on carotid and basilar systems, the internal carotid artery has a rostral and a caudal branch, the middle cerebral.
The poor outcome in patients with basilar artery occlusion did not improve in more recent years 82% in 1997 to 2002 v 74% in 1991 to 1996, despite more patients being diagnosed with a. Heralding manifestations of basilar artery occlusion with. The majority of cases are due to thrombosis due to atherosclerotic disease, but can also be. Nov 18, 2008 acute occlusion of the basilar artery is a neurological emergency that has a high risk of severe disability and mortality. Dizziness, diplopia, wallenberg syndrome, and even lockedin syndrome are some of the. Outcome in patients with basilar artery occlusion treated.
The arteries are lined by endothelium, which allows the blood to flow smoothly. The diagnosis may be difficult and need close clinicoradiological correlation. Acute basilar artery occlusion is a fatal disease associated with poor survival and mortality rates approaching 90% without treatment 5. Our study describes the early symptoms and signs of 85 patients with either basilar artery occlusion or bilateral distal vertebral artery occlusion documented by selective angiography. Relationship between clot location and outcome after. The main cause of thrombosis of the basilar artery is the formation of a thrombus in the wall of the basilar artery. This condition accounts for about 1% to 4% of all ischemic strokes and is generally related to local atherothrombosis or cardioembolism. Occlusion due to atherosclerotic disease is most prevalent in patients of advanced age, usually. Doppler flow ultrasound revealed extensive arterial thromboembolus.
Basilar artery thrombosis was confirmed by pathological study in all these patients. Here we present the first case of delayed intraarterial thrombolysis of a basilar artery thrombosis associated with a large saccular. The natural history of vertebral basilar arterial disease is frequently benign. Arterial thrombosis is generally more serious because the supply of oxygen and nutrition to an area of the body is halted. Until the recent developments in local intraarterial or systemic intravenous fibrinolysis, interest in early. Schonewille wj, algra a, serena j, molina ca, kappelle lj.
Basilar artery thrombosis statpearls ncbi bookshelf. Shortness of breath sudden chest pain a feeling of apprehension sudden collapse coughing sweating bloody phlegm coughing up blood. Vanderbilt university medical center stroke symposium 20 41 basilar artery occlusion complete basilar syndrome impairment of consciousness bilateral sensory and motor dysfunction cerebellar signs cranial nerve signs indicative of site top of basilar occlusion. Alongside heparinization, fibrinolytic therapy is recommended if there are signs of ischemia in the lower extremity. Congenital pathologies, such as an abnormal structure of the walls of blood vessels, a violation of the vascular tone. Venous thromboembolism vte is the most common vascular disease after acute myocardial infarction and stroke. Basilar artery occlusion is a lifethreatening vascular pathology that can initially present with relatively mild and nonspecific symptoms. Many prevalent acute vascular diseases are due to thrombus formation within a vessel, including myocardial infarction, thrombotic cerebrovascular events, and. Case report a vertebral artery dissection with basilar. To identify factors that predict survival and good neurologic outcome in patients undergoing basilar artery. Basilar artery occlusion is assumed to carry a grave prognosis, with mortality rates of up to 90%. Arteries carry oxygen rich blood away from the heart to the body. The prevailing concept is that an acute blockage of a coronary artery due to a thrombosis, a blood clot, is the main cause of heart attack. Background and purpose the benefits of mechanical thrombectomy mt in basilar artery occlusions bao have not been explored in recent clinical trials.
Acute occlusion of the basilar artery may cause brainstem or thalamic ischemia or infarction. Its dangerous as it can obstruct or stop the flow of blood to major organs. Basilar artery occlusion bao is a devastating form of stroke that carries a high rate of mortality and severe disability, especially if recanalization does not occur. Deep vein thrombosis dvt common signs and symptoms of pe. Endovascular treatment for acute basilar artery occlusion. The diagnosis is often challenging due to considerable heterogeneity of clinical signs and symptoms. Fatal basilar thrombosis possibly related to minor cervical. The reasons for the development of thrombosis of the basilar artery may be as follows. Arterial thrombosis article about arterial thrombosis by. Superior mesenteric artery thrombosis and partial dissection managed medically. Endovascular treatment of basilar artery stenosis with. Although these may occur anywhere, each of these have predilections for different segments of the basilar artery. We report a case of an acute basilar artery occlusion.
Averysmallnumberoriginate in the common carotid itself and a few at higher levels of the internal carotid, in some cases even as high as the intracranial portion of the vessel. This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute bao. Acute occlusion of the basilar artery is a life threatening event, which carries a terrible prognosis. Mechanical thrombectomy for basilar artery thrombosis. A patient with acute mesenteric artery thrombosis presents with acuteonset abdominal pain. Thrombosis may occur in veins venous thrombosis or in arteries arterial thrombosis. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Basilar artery occlusion is a potentially lifethreatening subset of the larger category of posterior circulation strokes, carrying 80% fatality rate without treatment. Delayed treatment of basilar thrombosis in a patient with a. Acute basilar artery occlusion radiology reference article. The majority of cases are due to thrombosis due to atherosclerotic disease, but can also be secondary to cardioembolic or infectious sources. Arteries are blood vessels that carry blood from the heart to the rest of the body and the heart muscle. In 28 patients with vertebro basilar or basilar artery thrombosis brainstem auditory evoked potentials baeps and somatosensory evoked potentials seps have been recorded.
Given lesions will have different effects in different patients. Basilar artery thrombosis clinical meet slideshare. The basilar artery is a vital vessel contributing to the posterior cerebral circulation. Delayed thrombolysis or endovascular therapy has been performed with some success in patients who present after 3 hours of symptom onset. It is a true neurointerventional emergency and, if not treated early, brainstem infarction results in rapid deterioration in the level of consciousness and ultimately death. Relationship between clot location and outcome after basilar artery thrombolysis dewitte t. Feb 24, 2014 thrombosis is the most common complication during cardiac catheterization via femoral artery access. Relationship between clot location and outcome after basilar. Recanalization is the promising strategy for bao therapy 6. The patient may give a history of postprandial pain, typically occurring 1020 minutes after eating and lasting up to an hour. Azharuddin, muhammad, ananta subedi, shil patel, and sweta chandra. Pdf evoked potentials in basilar artery thrombosis. Often, complete recovery will follow one or two mild episodes, and no further trouble will occur. We compared outcomes and procedural complications of mt in bao with anterior.
When a coronary stenosis tears apart, a thrombosis develops to close the injury. Jun 28, 2012 cerebellar and cerebral infarctions caused by the syndrome of cervical rib with thrombosis of subclavian artery are very unusual. The pain is diffuse, and the patient may complain of bloody stools. Results the ct attenuation values of the basilar artery on the plain and contrastenhanced scans in the 11 cases of occlusion are given in table 1. Intraluminal lling defect in basilar artery axial view with contrast medium b coronal view with contrast medium occlusion of basilar artery between arrows, thin caliber of right superior cerebellar artery. Basilar artery occlusion usually causes severe disability or death. The most dangerous of all known thromboses is thrombosis of the basilar artery.
Heparin and its derivatives in the treatment of arterial thrombosis. Acute occlusion of the basilar artery can be due to either thromboembolism, atherosclerosis or propagation of intracranial dissection. A endovascular protocols seem to give higher recanalisation rates than intravenous thrombolysis. Hyperdense basilar artery an early computed tomography. Arterial thrombosis is a blood clot that develops in an artery. Intravenous heparin was prescribed for three days at a dose of 27. Pdf striatocapsular infarction is a distinct form of stroke, but few histopathological studies have been performed concerning acute lesions.
Arterial thromboses are responsible for heart attacks, strokes and peripheral vascular disease. American journal of cardiovascular disease research, 42, 1517. The duration and severity of an arterial occlusion can cause serious complications. Jan 11, 2019 acute basilar artery thrombosis is associated with a poor prognosis. Basilar artery occlusion is an infrequent form of acute stroke, especially in adolescence, which might lead to death or. The pathogenesis of coronary artery disease and the acute coronary. A angiography of right vertebral artery showing basilar artery occlusion arrow. In this case the end organ damage is already apparent. Basilar artery occlusion has been reported in 2 out of postmortem cases. Endovascular treatment versus standard medical treatment. To evaluate the impact of extensive baseline ischemic changes on functional outcome after thrombolysis of basilar artery occlusion bao, and to study the effect of time to treatment in the.
We describe a neonate of 38week and 6day gestation born by lower uterine cesarean section for breech presentation, where it was evident on delivery that there was significant edema of the right arm from the deltoid to the distal tips of the fingers. Clinical features of proven basilar artery occlusion. Basilar artery occlusion bao is an uncommon cause of stroke generally associated with a high mortality rate and a poor functional outcome in survivors. Mechanisms of thrombosis maureane hoffman, md, phd professor of pathology. Atherosclerosis plaques are the most common lesion found in the basilar artery system, causing vascular stenosis or occlusion 7. The probability that the basilar thrombosis might be the cause of a sudden death has been described in the literature since 1868. Treatment of femoral artery thrombosis with streptokinase and. Treatment usually involves catheterdirected intraarterial thrombolysis. An embolic origin of basilar artery occlusion from an arteriosclerotic vertebral artery lesion was assumed to be an important mechanism.
What is the role of anticoagulant and antiplatelet. Basilar artery stroke is a rare but very devastating condition comprising around 3% of all ischemic strokes1. When a blood vessel a vein or an artery is injured, the body uses platelets thrombocytes and fibrin to form a blood clot to prevent blood loss. Design, setting, and participants this nonrandomized cohort study, the evt for acute basilar artery occlusion study basilar study, was a nationwide prospective registry of consecutive. Basilar artery occlusion occlusion and stenosis of.
Diagnosis is often delayed, or even missed, as a result of the variety of clinical presentations seen with this condition. Multiple cranial nerve palsies and hemiparesis were the most common clincal. At all centers, patients were considered eligible for thrombectomy if the thrombectomy could be started within 12 hours of the estimated time of stroke onset and had an angiographically confirmed occlusion in the basilar artery. Eventually, quadriparesis, dysarthria, altered level of consciousness. Get a printable copy pdf file of the complete article 596k, or click on a page image below to browse page by page. Basilar artery the basilar artery lies at the front of the brainstem in the midline and is formed from the union of the two vertebral arteries. If the ct attenuation value of the vessel is higher than that of blood, basilar artery occlusion. Imaging in acute basilar artery thrombosis springerlink. The basics of treating symptomatic basilar artery thrombosis. We report the case of a 49yearold male patient with a right cervical rib compression leading to subclavian arterial thrombosis and both cerebellar and cerebral infarctions secondary to retrograde thromboembolisation.
Recanalisation, survival, and functional outcomes in series of patients with basilar artery occlusion figure based on studies listed in table 4. Basilar artery occlusion in a teenaged boy treated with intra. Stroke from basilar artery disease is very variable and can range from a mild lacunar stroke, resulting from a small penetrator disease, to a large, devastating syndrome with extensive destruction of the brainstem from complete or almost complete basilar occlusion. The normal basilar artery imaged on plain ct scans has an attenuation value not higher than that of whole blood. Thrombosis of one of the arteries leading to the heart heart attack. Full text is available as a scanned copy of the original print version. Pain associated with dvt is often described as being a cramp or ache in the calf or thigh. Background and purpose basilar artery occlusion bao is an infrequent form of acute stroke, which invariably leads to death or longterm disability if not recanalized. Arterial thrombosis is when the blood clot blocks an artery.
161 605 411 1469 1616 124 238 1120 473 768 984 394 369 736 258 413 256 1065 1243 1418 829 1582 178 143 986 914 254 475 746 1383 322 238 1166 840 120 1118