Purpose Hyperacute vertebrobasilar ischemic stroke is difficult to treat with mechanical thrombectomy. The best thrombectomy can be done through tortuous routes and small vessels, but it should be done as soon as possible. The dominant vertebral artery (VA) is the most accessible route, but other methods should be considered in some cases. We will discuss situations where the nondominant VA pathway is a better choice.

Methods Between January 2014 and December 2022, 372 of 2,785 patients diagnosed with hyperacute ischemic stroke underwent mechanical thrombectomy. Fifty patients were treated for vertebrobasilar ischemic stroke and underwent recanalization therapy through either dominant or non-dominant VA. We evaluated patient characteristics and clinical course, highlighting the pros and cons of the access routes.

Results Patients with hyperacute vertebrobasilar ischemic stroke were predominantly male (male:female = 36:14), mean age was 41±11.61 years, and the National Institutes of Health Stroke Scale (NIHSS) mean was 18.42. Large artery atherosclerosis and cardioembolism were the main etiologic factors in the TOAST classification (23% and 18%, respectively). 41 patients were treated through dominant VA and 9 patients underwent thrombectomy through non-dominant VA. 74% of cases are final modified treatment in cerebral ischemia (mTICI) score 3. However, no statistical significance is seen in the comparison between the dominant and non-dominant VA approaches.

Conclusions Undoubtedly, the fastest treatment is best through the dominant VA. Nondominant VA may be another option in situations where it is accessible, stable, or less risky despite nonvisualized VA in angiogram.

Disclosures G. Lee: None. C. Yang: None. C. Kang: None. J. Kim: None. J. Joo: None. Y. Chung: None. J. Huh: None. J. Rhim: None.