Endovascular Recanalization for Chronic Symptomatic Intracranial Vertebral Artery Total Occlusion

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.

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

“…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.…”

Endovascular recanalization of symptomatic non–acute intracranial artery occlusion: Procedural and mid-term clinical outcomes in the anterior circulation

“…3,4 Several studies on endovascular recanalization of subacute or chronic intracranial occlusion have been reported with acceptable safety profiles. [4][5][6][7][8][9] However, the sample size in these studies was relatively small with a mixture of anterior and posterior circulation, and most patients were reported with successful vessel recanalization. 4,6 Therefore, we cannot get instructional information for patients with failed recanalization of the occluded vessel as to whether best medical management or extra-intracranial bypass would be the priority choice for them.…”

Case Report: Double Micro-Guidewire Technique for Emergent Rescue of Proximal Stent Collapse During Recanalization of Nonacute Occlusion of Vertebral Artery

“…Given the high incidence and recurrent symptoms in spite of antiplatelet treatment, revascularization of the occluded intracranial vertebral artery using endovascular stenting and angioplasty has been attempted within the past decade and considered to be technically accessible because of fast development of endovascular management. However, the safety and efficacy of endovascular stenting and angioplasty still need further investigation (15)(16)(17). During the recanalization of intracranial vertebral artery occlusion, the major technical challenge is traversing the occlusion site with a guidewire even though other factors, such as the length and stage of the occlusion, may also affect the feasibility and outcome.…”