Vertebral tandem occlusion - small clot burden and severe symptoms
Presentations of case resolutions in the form of a “serious game”. Vertebral tandem stroke with early recurrence from the stump of artery with unclear etiology (clot migration vs. hemodynamic). You will find also tips and tricks of dealing with this type of occlusion during mechanical thrombectomy.
Small clot burden (for example P2 occlusion) and severe and fluctuating symptoms:
PCoMs preserve the flow through the top of basilar artery so it is not so much in danger when occluded as in the cases of PCoM aplasia/hypoplasia where there is no backflow.
Treatment of posterior stroke in publications and guidelines:
P2 occlusions in publications:
VERTEBRAL TANDEM OCCLUSION STRATEGY:
R. Nogueira: proximal aspiration, distal lesion treated first, stenting of proximal lesion
E. Abergel: balloon angioplasty of proximal lesion, while partially deflate go up with base catheter over the balloon, stent if needed after
T. Jovin: balloon angioplasty of proximal lesion, base catheter to distal lesion, if stenting - balloon-mounted stent
D. Lopes: proximal aspiration, balloon angioplasty of proximal lesion, distal lesion treated, balloon-mounted stent
T. Anderson: BCG, peripheral balloon angioplasty over 0,035 in wire and balloon-mounted stenting of proximal lesion, distal lesion treated
TIPs and TRICKs:
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