Endovascular recanalization for chronic symptomatic intracranial vertebral artery total occlusion.

Ziqi Xu,Zhongrong Miao,Edward Ho Chung Wong,Ning Ma,Feng Gao,Dapeng Mo,Liqun Jiao

doi:10.1155/2014/949585

Abstract

Purpose. The outcome of recanalization in patients with chronic symptomatic intracranial vertebral artery (ICVA) total occlusion is poor. This paper reports the technical feasibility and long-term outcome of ICVA stenting in patients with chronic symptomatic total occlusion. Methods. Retrospective review of our prospectively maintained intracranial intervention database to identify patients with symptomatic total occlusion of ICVA with revascularization attempted >1 month after index ischemic event. Results. Eight patients (mean age 58 years) were identified. One had stroke and 7 had recurrent transient ischemic attacks. Four had bilateral ICVA total occlusion and 4 had unilateral ICVA total occlusion with severe stenosis contralaterally. Seven of 8 patients underwent endovascular recanalization, which was achieved in 6. Periprocedural complications included cerebellum hemorrhage, arterial dissection, perforation, and subacute in-stent thrombosis which occurred in 3 patients. One patient died of cerebellum hemorrhage. The other patients improved clinically after endovascular therapy. Conclusions. Stent-supported recanalization of ICVA total occlusion is technically feasible, and may become a viable treatment option in selected patients.

Highlights

Intracranial vertebral artery (ICVA) is a common site of atherosclerosis, often involved bilaterally [1, 2]
Patients with bilateral ICVA occlusion usually present with recurrent attacks of dizziness, visual disturbance, and ataxia, and some may be disabled by infarction of regions supplied by the posterior circulation [2]
We retrospectively reviewed our prospectively maintained neurointerventional database from March 2007 to July 2012, to identify patients intended for ICVA recanalization

Summary

Introduction

Intracranial vertebral artery (ICVA) is a common site of atherosclerosis, often involved bilaterally [1, 2]. Patients with bilateral ICVA occlusion usually present with recurrent attacks of dizziness, visual disturbance, and ataxia, and some may be disabled by infarction of regions supplied by the posterior circulation [2]. Development of endovascular intervention and improved operator experience have rendered angioplasty and stenting a potential treatment option for these patients but its safety and efficacy remains uncertain [3,4,5]. To evaluate the feasibility and efficacy of the endovascular therapy for them is urgent. We illustrated the feasibility of elective (at least 1 month after ischemic event) endovascular recanalization for symptomatic ICVA total occlusion and their long-term outcome

Methods

Results

Conclusion