Endovascular Treatment for Acute Ischaemic Stroke Caused by Vertebral Artery Dissection: A Report of Three Cases and Literature Review

Abstract

Vertebrobasilar artery dissection is an uncommon cause of acute ischaemic stroke (AIS). Optimal endovascular management has not been established. This study aimed to share our experience with endovascular reperfusion therapy for vertebrobasilar artery occlusion due to vertebral artery dissection (VAD). We retrospectively reviewed 134 consecutive patients with AIS who received urgent endovascular reperfusion therapy between November 2017 and November 2019. Three patients diagnosed with VAD were investigated. The evaluation included mechanisms of vertebrobasilar artery occlusion due to VAD, variations in endovascular procedures, and functional outcomes. Dissections at the V3, V4 and extension of V3 to V4 segments were seen in one patient each. The mechanism of AIS was different in each patient: occlusion of the distal non-dissected artery due to an embolus from the dissection site ( distal occlusion ), haemodynamic collapse of the entire vertebrobasilar artery system due to the arterial dissection itself ( local occlusion ), or coexistence of distal occlusion and local occlusion ( tandem occlusion ). The endovascular reperfusion therapy was performed corresponding to the abovementioned mechanisms: mechanical thrombectomy for distal occlusion , stenting for local occlusion , and a combination of thrombectomy and stenting for tandem occlusion . In all three patients, effective recanalization and functional independence (modified Rankin Scale scores of 0–2 at 90 days after the onset) were achieved. Endovascular treatment corresponding to the individual mechanism of AIS may improve patient outcomes.

Efficacy and safety of 3‐n‐butylphthalide combined with endovascular treatment in acute ischemic stroke due to large vessel occlusion

“…Therefore, it is important to timely treat these events. Successful reperfusion via EVTs promotes the likelihood of a good functional outcome, and neuroprotective drugs may be more effective when complete reperfusion is achieved 25 . Therefore, we chose patients who underwent EVT.…”

“…Successful reperfusion via EVTs promotes the likelihood of a good functional outcome, and neuroprotective drugs may be more effective when complete reperfusion is achieved. 25 Therefore, we chose patients who underwent EVT. Second, the works of the literature suggest that the hypoperfusion intensity ratio, 26 the level of collateral flow, 27 and net water uptake 28 and so on are all useful imaging biomarkers that are associated with treatment effects in acute stroke.…”

“…Successful reperfusion via EVTs promotes the likelihood of a good functional outcome, and neuroprotective drugs may be more effective when complete reperfusion is achieved. 25 Therefore, we chose patients who underwent EVT. Excitotoxicity, oxidative stress, and inflammation have been identified as key factors in ischemic cell death within the penumbra.…”

“…There were 628 (37.5%) and 1138 (62.5%) patients in the NBP and non-NBP groups, respectively. Compared with the non-NBP group, patients in the NBP group had a lower baseline NIHSS score (16 [11][12][13][14][15][16][17][18][19][20][21][22] vs. 18 [13][14][15][16][17][18][19][20][21][22][23][24][25][26] 42.7% vs. 50.2%, p = 0.006). Other baseline characteristics did not differ significantly between the groups (p > 0.05) (Table 1).…”

Acute Placement of Telescoping Open Cell Stents and Thrombectomy for Progressive Symptomatic Vertebrobasilar Dissection: 2-Dimensional Operative Video

“…4 There are reports in the literature documenting the use of stents for reconstruction of occlusions secondary to vertebral artery dissections. [5][6][7][8][9][10][11][12][13][14] We present the case of a 27-year-old woman who presented after a syncopal event with headaches, ptosis, diplopia, and ataxia. Computed tomography angiogram demonstrated left vertebral artery dissection, near occlusion of the basilar artery, and a hypoplastic right vertebral artery.…”