Background There remains major uncertainty regarding the optimal therapy for symptomatic nonacute extracranial vertebral artery occlusion (EVAO). Endovascular recanalization for EVAO is technically challenging, and limited data are available. This research aimed to report a multicenter clinical experience of endovascular recanalization for symptomatic nonacute EVAO and establish a novel angiographic classification.
Methods From June 2011 to December 2019, 50 symptomatic nonacute EVAO patients treated with endovascular recanalization in three regional referral stroke centers were retrospectively analyzed. All patients were categorized into four groups based on the angiographic classification. The rates of technical success, periprocedural complications, any stroke or death within 1 month, and follow-up data were assessed.
Results The rates of technical success, periprocedural complications, and any stroke or death within 1 month were 86.0% (43/50), 12.0% (6/50), and 4.0% (2/50), respectively. The recanalization rates gradually decreased from Type A to Type D (100%, 94.7%, 80%, and 63.6%, respectively; P=0.007). The EVAO patients in the Type A group with tapered stump and short-segment occlusions showed excellent recanalization effects, with 100% technical success rates and no complications. Conversely, the lowest recanalization rate of 63.6% (7/11) and the highest periprocedural complication rate of 27.3% (3/11) were observed for the Type D group.
Conclusions Endovascular recanalization for symptomatic nonacute EVAO is technically feasible, especially Type A EVAO patients, which can provide an alternative treatment option for recurrent vertebrobasilar ischemia despite optimal medical therapy. The angiographic categorization established in this study is conducive to the selection of suitable patients prior to treatment decision.
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FG and HZ contributed equally.
Contributors Feng Gao, MD; study concept and design, study conduct, draft paper, critical revision of manuscript. Hongbo Zheng, MD; study concept and design, study conduct, draft paper, critical revision of manuscript. Feng Gao and Hongbo Zheng contributed equally to this work. Xu Guo, MD; study conduct, acquisition of data, statistical analysis. Xuan Sun, MD; study conduct, acquisition of data. Zhongrong Miao, MD; study conduct, critical revision of manuscript.
Funding This study was funded by National Key R&D Program (2018AAA0102600).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The retrospective study was approved by the Institutional Review Board of Beijing Tiantan hospital (KY 2020-115-01), and the requirement for patient informed consent was waived for review of patient records and images.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The manuscript has not been fully published or submitted elsewhere. Our corresponding author takes full responsibility for the data, the analyses, and interpretation, and the conduct of the research.
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