Safety and Blood-Flow Outcomes for Hybrid Recanalization in Symptomatic Refractory Long-Segmental Vertebral Artery Occlusion—Results of a Pilot Study

Ma, Yan; Yang, Bin; Xia, Lu; Gao, Peng; Li, Feng

doi:10.3389/fneur.2020.00387

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Open surgery could not only obtain proximal revascularization but also make the real lumen (the interface between the plaque and vessel wall) visible (7,34). A technique reported in previous studies was the insertion of a microwire into the real lumen of the VA to ensure the completion of subsequent thrombectomy and stenting (6,35). However, considering the mostly straight anatomy of the proximal ICA and the V1 segment and the performance of preoperative angiography evaluation, the Fogarty balloon was directly inserted through the exposed proximal ICA or V1 segment to conduct the surgical thrombectomy in our center.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, complementary endovascular thrombectomy or stenting could also achieve distal recanalization and avoid destroying the collaterals from the thyrocervical or costocervical trunk (35). In addition to wound hematomas and infections, Horner syndrome and chylothorax are inherent risks of the process of VA endarterectomy and transposition (1,7).…”

Section: Discussionmentioning

confidence: 99%

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Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

et al. 2020

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Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatment of in-stent restenosis and occlusion.Methods : A cohort of 12 refractory patients with in-stent restenosis or occlusion who underwent hybrid recanalization, a combination of endarterectomy and endovascular intervention, were retrospectively analyzed. Medical records, including presenting symptoms, comorbidities, contralateral ICA/VA findings, use of antiplatelet drugs, postoperative complications, and angiographic outcomes, were collected.Results : Among 415 consecutive patients with ICA, common carotid artery, and V1 segment lesions, 12 refractory patients (2.89%) with 13 cases were enrolled in our study (1 female and 11 male). All patients underwent successful hybrid recanalization. There were no cases of postoperative stroke or death. Only two patients sustained hoarseness, but it resolved within 2 weeks after surgery. Three patients were treated with dual antiplatelet (aspirin and clopidogrel), seven with single antiplatelet (aspirin), one with single antiplatelet (clopidogrel), and one with single antiplatelet (ticagrelor). All patients were followed up in the outpatient department according to the protocol, with a mean follow-up period of 13 months (range, 6–24 months). No death or recurrent symptoms occurred during the regular follow-up period.Conclusion : The hybrid technique maybe a safe and feasible treatment option to recanalize in-stent restenosis or occlusion with acceptable complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

et al. 2020

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“…Indirect bypass attaches a well-perfused tissue to the surface of ischemic hemisphere, leading to angiogenesis that alleviates ischemia. In combined bypass surgery, both strategies are applied ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Potential of unilateral combined bypass surgery to accelerate contralateral radiological progression in pediatric moyamoya disease

Luo,

Feng,

et al. 2023

Quant Imaging Med Surg

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Background Surgical cerebral revascularization is recommended for treating pediatric moyamoya disease (MMD). However, whether unilateral combined bypass surgery can cause disease progression on the contralateral side is uncertain. The study aimed to investigate the vascular architecture and regional cerebral blood flow (rCBF) status of patients with pediatric MMD after successful unilateral combined bypass surgery and to identify the possible risk factors. Methods Pediatric patients diagnosed with MMD and admitted to Xuanwu Hospital who underwent combined bypass surgery between 2019 and 2021 were enrolled. Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) with arterial spin labeling (ASL) were performed to investigate the vascular architecture and rCBF during surgery and at short-term follow-up. Suzuki’s angiographic staging and moyamoya vessel grading system were both used. Progression was defined as an increase in either Suzuki stage or moyamoya vessel grade detected after unilateral surgery. All analyses were performed with conventional statistic methods. Results A total of 27 successive patients with a median age of 8 [interquartile range (IQR), 5–14] years old were identified. On the non-operated (non-OP) side, 11 (40.7%) patients demonstrated progression, all of whom showed an increase in the moyamoya vessel grade, and 5 also displayed Suzuki stage progression during the median 4.7 (IQR, 3.7–5.7) months follow-up. However, rCBF barely changed on the non-OP side compared to preoperation [preoperation: median, 49.6, (IQR, 42.9–61.1) mL/100 g/min; postoperation: median, 50.2, (IQR, 43.5–59.3) mL/100 g/min; P=0.445]. Conclusions Combined bypass surgery might accelerate the radiological progression on the contralateral side, which occurs before the decline of rCBF. Those with earlier Suzuki stage MMD of the non-OP side are prone to rapid progression after unilateral combined revascularization.

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“…Although the optimal strategy for preventing stroke occurrence in symptomatic patients with VA occlusion is controversial and empirical, the perspective that open surgery and endovascular treatment are important complementary treatments for symptomatic VA stenosis or occlusion refractory to optimal medical therapy seems to be well recognized ( 5 – 7 ). Open surgery including bypass surgery, vertebral endarterectomy, and hybrid surgery has been considered as a therapeutic option for VA occlusion ( 8 – 10 ), which, however, is not commonly performed due to the complexity and serious complications of these procedures ( 6 ). Recently, endovascular revascularization has been reported as a feasible treatment for VA occlusion with a high success rate of 86% and a low rate of periprocedural complications of 12% ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: Retrograde endovascular recanalization of vertebral artery occlusion with non-tapered stump via the deep cervical collateral

Qiu,

Kang,

Sun

et al. 2023

Front. Neurol.

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IntroductionVertebral artery (VA) occlusive disease is the major cause of posterior circulation ischemic stroke. Endovascular recanalization has been reported as a feasible treatment for patients with symptomatic VA occlusion refractory to optimal medical therapy. However, VA occlusion with non-tapered stump exhibits a low technique success rate when treated by antegrade endovascular therapy because of increased difficulty in passing the guidewire into the occluded segment. Herein, we presented a novel endovascular approach to recanalize chronically occluded VA with a non-tapered stump using a retrograde method via the deep cervical collateral, which has not been reported before.Case presentationThe present case was a patient with VA ostial occlusion with non-tapered stump and distal severe stenosis of the left VA who had recurrent posterior circulation transit ischemic attacks under optimal medical therapy. CT angiography demonstrated proximal non-tapered occlusion and distal severe stenosis of the left VA, and that the right VA did not converge with the left VA into basilar artery. Endovascular treatment was recommended and performed on this patient. However, antegrade endovascular recanalization of the left VA origin occlusion failed because the micro guidewire was unable to traverse the occluded segment. Fortunately, robust collateral from the deep cervical artery to the V3 segment of the left VA developed, in which we advanced the micro guidewire to the V3 segment of the left VA and reversely passed the micro guidewire through the occluded segment. Then, the occlusion and stenosis of the left VA were successfully resolved with angioplasty and stenting. After the procedure, the patient reported no neurological symptoms under medical therapy during 3-month follow-up.ConclusionAntegrade endovascular recanalization of VA occlusion with a non-tapered stump is a challenge. The retrograde endovascular method via the cervical collateral may be an alternative for this type of VA occlusion, which requires further exploration.

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Safety and Blood-Flow Outcomes for Hybrid Recanalization in Symptomatic Refractory Long-Segmental Vertebral Artery Occlusion—Results of a Pilot Study

Cited by 5 publications

References 16 publications

Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

Potential of unilateral combined bypass surgery to accelerate contralateral radiological progression in pediatric moyamoya disease

Case report: Retrograde endovascular recanalization of vertebral artery occlusion with non-tapered stump via the deep cervical collateral

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