scholarly journals Staged Endovascular Treatment for Symptomatic Occlusion Originating From the Intracranial Vertebral Arteries in the Early Non-acute Stage

2021 ◽  
Vol 12 ◽  
Author(s):  
Hongzhou Duan ◽  
Li Chen ◽  
Shengli Shen ◽  
Yang Zhang ◽  
Chunwei Li ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Medical Therapy ◽  
Artery Occlusion ◽  
Acute Stage ◽  
Residual Stenosis ◽  
Vertebral Artery Occlusion ◽  
Vertebrobasilar Artery ◽  
Ischemic Events

Background: The ideal treatment for patients who survive from acute vertebrobasilar artery occlusion but develop aggressive ischemic events despite maximal medical therapy in the early non-acute stage is unknown. This paper reports the technical feasibility and outcome of staged endovascular treatment in a series of such patients with symptomatic intracranial vertebral artery occlusion.Methods: Ten consecutive patients who presented with aggressive ischemic events in the early non-acute stage of intracranial vertebral artery occlusion from Jan 2015 to Nov 2020 were retrospectively reviewed. Among them, eight male and two female patients with a mean age of 66.7 years developed aggressive ischemic events, and the NIHSS score was elevated by a median of 7 points despite medical therapy. All patients received staged endovascular treatment 4–21 days from onset, at an average of 11 days. The strategy of staged treatment was as follows: first, a microwire was passed through the portion of the occlusion, which was then dilated with balloon inflation to maintain the perfusion above TICI grade 2b. Then, with the use of antiplatelet drugs, the residual intravascular thrombus was gradually eliminated by the continuous perfusion and an activated fibrinolytic system, leaving the residual stenosis. A second stage of angioplasty with stent implantation was subsequently performed if residual stenosis was ≥50%. The NIHSS scores and mRS scores were compared between pre- and post-endovascular treatment groups and in the follow-up period.Results: Technical success was achieved in 9 patients who received staged endovascular treatment (perforation occurred in one patient during the first stage). The NIHSS scores were significantly improved, with a median score 7 points lower on discharge compared with the scores for the most severe status. Favorable outcomes with mRS score ≤ 2 were achieved in 7 and 9 patients at the 3-month follow-up and the latest follow-up, respectively, which was better than the preoperative status.Conclusion: Staged endovascular treatment might be a safe, efficient, and viable option in carefully selected patients with symptomatic intracranial vertebral artery occlusion in the early non-acute stage. However, this needs to be confirmed by further investigation, preferably in a large, controlled setting.

scholarly journals Endovascular Recanalization for Nonacute Intracranial Vertebral Artery Occlusion According to a New Classification

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3340-3343 ◽  
Author(s):  
Feng Gao ◽  
Xuan Sun ◽  
Huijun Zhang ◽  
Ning Ma ◽  
Dapeng Mo ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Type I ◽  
New Classification ◽  
Endovascular Recanalization ◽  
Type Iv ◽  
Vertebral Artery Occlusion ◽  
Procedural Complications ◽  
Perioperative Complication

Background and Purpose: Endovascular recanalization for patients with nonacute intracranial vertebral artery occlusion remains clinically challenging. We aim to evaluate the feasibility and safety of endovascular recanalization for nonacute intracranial vertebral artery occlusion and propose a new angiographic classification. Methods: Fifty patients with symptomatic atherosclerotic nonacute intracranial vertebral artery occlusion from January 2015 to December 2019 were analyzed, retrospectively. The rate of recanalization, peri-procedural complications, and follow-up results were evaluated. All patients were divided into 4 groups according to an angiographic classification. Results: Among the 50 patients, 38 (76%) achieved successful recanalization. Any stroke or death within 30 days was 4% (2/50). From type I to type IV, the recanalization rate gradually decreased (94.1%, 76.9%, 70%, and 50%, respectively, P =0.012), while the perioperative complication rate gradually increased (0.0%, 7.7%, 20%, and 50%, respectively, P =0.001). Conclusions: Endovascular recanalization may be feasible and safe for carefully selected patients with symptomatic atherosclerotic nonacute intracranial vertebral artery occlusion and, therefore, represents an alternative treatment, especially for type I and type II patients.

scholarly journals Incidence of Ischemic Complications after Endovascular Treatment for Ruptured Dissecting Vertebral Artery Aneurysms

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 157-162 ◽  
Author(s):  
T. Kudo ◽  
K. Iihara ◽  
T. Satow ◽  
K. Murao ◽  
S. Miyamoto
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Acute Stage ◽  
Radiological Findings ◽  
Complete Obliteration ◽  
Ischemic Complications ◽  
Dissecting Aneurysms

We analyzed the incidence of ischemic complications after internal trapping for ruptured VA dissecting aneurysms. Between April 2001 and August 2005, nine cases of ruptured VA dissecting aneurysms, five in women, “proximal” or distal (distal type) to the origin of the PICA, were treated by internal trapping in the acute stage after SAH. There were four cases of proximal type and five of distal type. The demographics of the patients were reviewed in the medical charts and radiological findings were evaluated by neuroradiologists. The dissected site was completely obliterated and PICA was preserved in all cases. Follow-up angiography performed five to 19 days after treatment revealed complete obliteration of the aneurysm and patency of the PICA. The incidence of perioprocedural ischemic complications for the PICA-distal type (75%) was higher than that for the PICA-proximal type (20%). Here we retrospectively analyzed and discussed the incidence and mechanisms of ischemic complications.

scholarly journals Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent

2020 ◽  
Vol 26 (6) ◽  
pp. 805-813
Author(s):  
Jun-Kyeung Ko ◽  
Chang-Hwa Choi ◽  
Lee Hwangbo ◽  
Hie-Bum Suh ◽  
Tae-Hong Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Good Alternative ◽  
Minor Stroke ◽  
Stent Restenosis ◽  
Vertebrobasilar Ischemia ◽  
Closed Cell ◽  
Carotid Wallstent ◽  
Permanent Neurological Deficit

Background Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high risk of morbidity associated with surgery. The purpose of this study was to evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for the treatment of VAOS. Methods The records of 72 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2006 to November 2018 were retrospectively evaluated. Results Of the 72 patients, 43 presented with transient ischemic attacks. Forty-seven patients (65.3%) manifested other brachiocephalic stenoses; of these, 40 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications ( n = 8, 11.1%) included sudden asystole ( n = 1), acute in-stent thrombosis ( n = 3), minor stroke ( n = 3), and stent shortening ( n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 13.0 months) was achieved in 49 patients and revealed in-stent restenosis in 1 patient (2.0%) and stent malposition by shortening in 2 patients (4.1%). Follow-up records were available in 57 patients (mean 15.6 months). Three of the 57 patients ( n = 3, 5.3%) had recurrent symptoms of vertebrobasilar ischemia and none was retreated. Conclusions Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow.

scholarly journals Vertebral Artery Occlusion in Duplex Color-Coded Ultrasonography

Stroke ◽  
2004 ◽  
Vol 35 (5) ◽  
pp. 1068-1072 ◽  
Author(s):  
Kozue Saito ◽  
Kazumi Kimura ◽  
Kazuyuki Nagatsuka ◽  
Keiko Nagano ◽  
Kazuo Minematsu ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebral Artery Occlusion

scholarly journals Vertebral artery occlusion associated with blunt traumatic cervical spine injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Youhei Nakamura ◽  
Kenji Kusakabe ◽  
Shota Nakao ◽  
Yasushi Hagihara ◽  
Tetsuya Matsuoka
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Cervical Spine Injury ◽  
Artery Occlusion ◽  
Spine Injury ◽  
Vertebral Artery Occlusion

Abstract P478: One-Year Outcome After Endovascular Treatment for Acute Basilar Artery Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Fengli Li ◽  
Hongfei Sang ◽  
Jiaxing Song ◽  
Zhangbao Guo ◽  
Shuai Liu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Conventional Treatment ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Treatment Groups ◽  
Excellent Outcome ◽  
Follow Up Study

Background and Objective: To report the results of clinical follow-up at 1 year among patients in the BASILAR registry. Design, Setting, and Participants: The BASILAR study was an investigator-initiated prospective registry, which consecutively enrolled stroke patients with acute basilar artery occlusion from 47 comprehensive stroke centers in China between January, 2014, and May, 2019. Patients were divided into conventional treatment or endovascular treatment groups according to the treatment their received. We assessed clinical outcomes 1 year after patients were enrolled in the BASILAR registry. Main Outcomes and Measures: The primary outcome was the score on the modified Rankin scale (range, 0 to 6 points, with higher scores indicating more severe disability) at 1 year assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. Secondary outcomes included categories scores of the modified Rankin scale at 1 year (0 to 1 [excellent outcome], 0 to 2 [good outcome], and 0 to 3 [favorable outcome]), and death from any cause during the 1-year period after enrollment. Results: Of the 829 patients who were enrolled in the original study, 1-year data for this extended follow-up study were available for 785 patients (94.7%). The distribution of outcomes on the modified Rankin scale favored endovascular treatment over conventional treatment (adjusted common odds ratio, 4.50; 95% confidence interval [CI], 2.81 to 7.29; P < 0.001). There were significant differences between the treatment groups in the percentage of patients who had excellent outcome, good outcome and favorable outcome. The cumulative 1-year mortality rate was 54.6% in the endovascular treatment group and 83.5% in the conventional treatment group (adjusted hazard ratio, 4.36; 95% CI, 2.69 to 7.29; P < 0.001). Conclusions and Relevance: In this extended follow-up study, the beneficial effect of endovascular treatment on functional outcome at 1 year in patients with acute basilar artery occlusion was similar to that reported at 90 days in the original study.

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