Treatment of Lateral Medullary Syndrome: Endovascular Reperfusion Approach
Lateral medullary syndrome results from ischemic injury to the lateral medulla, commonly due to vertebral or posterior inferior cerebellar artery occlusion. When an acute occlusion is identified in eligible patients, endovascular reperfusion is the primary interventional strategy.
Clinical Approach
Careful patient selection determines whether pharmacological, mechanical, or combined reperfusion is pursued. Eligibility criteria, timing thresholds, and contraindications to intravenous fibrinolysis each influence the choice of intervention. The full protocol specifies the decision pathway.
The reperfusion strategy involves intra-arterial fibrinolytic therapy or catheter-based mechanical thrombectomy — with specific guidance on device selection and when a combined approach is appropriate. These details, including the criteria that guide each choice, are set out in the complete regimen.
References
DOI: 10.1161/STR.0b013e318284056a
- Intra-arterial fibrinolysis is beneficial for treatment of carefully selected patients with major ischemic strokes of <6 hours' duration caused by occlusions of the MCA who are not otherwise candidates for intravenous rtPA (Class I; Level of Evidence B).
- When mechanical thrombectomy is pursued, stent retrievers such as Solitaire FR and Trevo are generally preferred to coil retrievers such as Merci (Class I; Level of Evidence A).
- The Merci, Penumbra System, Solitaire FR, and Trevo thrombectomy devices can be useful in achieving recanalization alone or in combination with pharmacological fibrinolysis in carefully selected patients (Class IIa; Level of Evidence B).
- Intra-arterial fibrinolysis or mechanical thrombectomy is reasonable in patients who have contraindications to the use of intravenous fibrinolysis (Class IIa; Level of Evidence C).
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