Introduction and Purpose A subset of patients with vertebrobasilar artery occlusion (VBAO) lasting more than 24 hours still suffered recurrent ischaemic events and progressive disability despite intensive medical therapy. The prognosis of these patients is extremely poor, with a high incidence of catastrophic brainstem and cerebellar infarction. Optimal management for these patients remains unknown. Recurrent symptoms despite aggressive medical treatment may be an indication for endovascular revascularisation and stenting. This study was to evaluate the technical feasibility, safety and short-term effects of recanalisation and stenting.
Materials and Methods Twenty-one consecutive patients with VBAO including 12 vertebral artery occlusion (VAO: occlusion not involving basilar artery) and 9 basilar artery occlusion (BAO) lasting more than 24 hours refractory to aggressive medical treatment were enrolled into this study and underwent recanalisation and stenting between February 2010 and November 2011. Data were retrospectively collected. The rate of recanalisation was evaluated radiographically and the functional outcome was examined using modified Rankin Scale (mRS) scores. Independent groups T-test, t’-test, Fisher Exact test or Nonparametric test were used according to the studied variables characteristics.
Results The median time between onset of symptoms and recanalisation was 1.7 months (IR, 0.9–5.2), and the median time between imaging-documented occlusion and endovascular recanalisation was 10.5 days (IR, Interquartile Range: 6.5–18); Median NIH Stroke Scale (NIHSS) at admission was 8 (IR, 2–13). Technique success ratio of recanalisation was 95.2%. There were 3 periprocedural complications. Median mRS score was 4 (IR, 2.5–5) prior to procedure and 4 (IR, 1–5) at discharge (P<0.05). One stroke and one death occurred within 30 days postprocedure. Mean duration of clinical follow-up was 6.9 months. One transient ischaemic attack, one stroke and one death occurred beyond 30-day postprocedure. Mean angiographic follow-up was 8.9 months in 7 patients. Three patients developed in-stent restenosis or occlusion, and two of them were symptomatic. Subgroup analyses revealed patients got better functional recovery (lower mRS) at discharge in patients with VAO (P<0.05) compared with their respective preoperative mRS scores and there was no significant difference in patients with BAO.
Conclusions Endovascular recanalisation and stenting for symptomatic VBAO lasting more than 24 hours was technically feasible and patients with VAO benefited from the treatment with significant functional recovery. However, the complexity of the procedure and high risk of complications should prompt extreme caution. Procedures should only be performed at high volume centres by experienced operators.
Disclosures Y. He: 1; C; Zhengzhou University. Z. Wang: None. T. Li: None.
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