Abstract

Endovascular Treatment of Acute Vertebrobasilar Artery Occlusion: One Institution’s Experience

Background: Acute vertebrobasilar artery occlusion (VBAO) is associated with high mortality and disability. Because of the poor efficacy of intravenous thrombolysis (IVT), greater attention has been directed to endovascular treatment (ET). Some randomized trials have demonstrated the effectiveness and safety of ET for anterior circulation infarction caused by proximal intracerebral artery occlusion. The improvement of these trials was attributed to the wider application of the Solitaire stent retriever. Stent retrievers work by temporarily deploying a stent that captures the thrombus and at the same time instantly restores blood flow. However, very few trials have addressed the effectiveness of ET for vertebrobasilar occlusion. Methods: Between 2011 and 2015, our study included 14 patients who received ET for ischemic stroke caused by acute VBAO in our department. Clinical, imaging, and angiographic data were collected. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade ≥2b. The modified Rankin scale (mRS) score was used to measure outcome. Results: The median patient age, NIHSS score on admission, Glasgow coma score (GCS), and onset-to-treatment interval were 61.5 (range 43–77), 24.0 (range 6–30), 8.5 (range 4–15), and 561.5 min (range 120–1080), respectively. Recanalization was successful (TICI grade ≥2b) in 12 of 14 patients (85.7%). One patient (7.1%) suffered a symptomatic intracerebral hemorrhage. At 3 months, 35.7% (5/14) overall had good and moderate outcome (mRS ≤3); 37.5% of patients treated with an SR procedure as the initial ET and 16.7% of patients treated with IAT as the initial ET had good outcome (mRS ≤2). Conclusions: ET for acute VBAO is associated with a high successful recanalization rate. Among ETs, the SR procedure may be superior to IAT at improving clinical outcome. An SR procedure rather than IAT should be the initial modality in patients with acute vertebrobasilar occlusion who undergo endovascular treatment. Careful patient selection may be the key to improving good outcome rate.


Author(s):

Weibiao Lu, Hongyu Qiao, Min Guan ,Zhilin Xiong , Wenxian Li , Zhen Jing, Lian Huang



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