Abstract
Background and Objectives: Previous studies on symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion that was refractory to medical therapy are rare. We aimed to assess the clinical features, imaging characteristics, endovascular treatment feasibility and follow-up outcomes of patients with this condition.Methods: Data from consecutive patients who had symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion and underwent endovascular recanalization from February 2016 to April 2020 were retrospectively collected in our prospective database. Clinical, imaging, procedural, and follow-up data were collected and analyzed.Results: Thirty-one patients, predominantly males, were enrolled in this study. These patients presented with recurrent/progressive stroke in the posterior circulation despite aggressive medical therapy. Angiographic analysis revealed asymmetric vertebral arteries due to unilateral hypoplasia and intracranial vertebral artery total occlusions in the dominant vertebral arteries, which were characterized by long lesion length and high clot burden. Multiple infarctions and perfusion defects in the posterior circulation were demonstrated by diffusion-weighted imaging and arterial spin labeling, respectively. Successful endovascular recanalization was achieved in 87.1% of the patients. Over a median clinical follow-up duration of 11.0 months, 74.1% of patients with successful recanalization achieved favorable clinical outcomes (mRS score ≤2).Conclusion: Symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion attributable to hypoperfusion is characterized by recurrent/progressive ischemic events, dominant intracranial vertebral artery total occlusion, long lesion length, and high clot burden. Endovascular recanalization of the dominant intracranial vertebral artery occlusion appears to be a feasible treatment for these patients.
Highlights
The intracranial vertebral artery (ICVA) is a common site of atherosclerotic occlusion that is often involved bilaterally; the ICVA has received the least attention, especially concerning the treatment of occlusive lesions [1]
We retrospectively reviewed our prospective stroke intervention database to identify consecutive patients who had symptomatic atherosclerotic non-acute ICVA total occlusion and underwent endovascular recanalization from February 2016 to April 2020
ICVA total occlusions occurred in the dominant vertebral arteries (VA) (Figure 1)
Summary
The intracranial vertebral artery (ICVA) is a common site of atherosclerotic occlusion that is often involved bilaterally; the ICVA has received the least attention, especially concerning the treatment of occlusive lesions [1]. A subset of patients survive the acute ICVA occlusion stage and continue to suffer recurrent strokes and transient ischemic attacks (TIAs) in posterior circulation despite aggressive medical therapy in the subacute and chronic period [1,2,3]. Previous studies have been rare and are limited by small sample sizes of patients with symptomatic atherosclerotic nonacute ICVA total occlusion that was refractory to medical therapy [6,7,8,9,10,11,12]. We aimed to assess the clinical features, imaging characteristics, endovascular treatment feasibility, and follow-up outcomes of these patients. Previous studies on symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion that was refractory to medical therapy are rare. We aimed to assess the clinical features, imaging characteristics, endovascular treatment feasibility and follow-up outcomes of patients with this condition
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