Vertebrobasilar Artery Calcification and Outcomes in Posterior Circulation Large Vessel Occlusion Thrombectomy

Abstract

Background and Purpose— Intracranial carotid artery calcification is associated with worse outcome in anterior circulation stroke patients who undergo endovascular thrombectomy. We investigated the association between vertebrobasilar artery calcification (VBAC) and outcome in patients undergoing endovascular thrombectomy for posterior circulation large vessel occlusion. Methods— Consecutive patients treated for posterior circulation large vessel occlusion from a prospective single-center registry were studied. VBAC was manually segmented on computed tomography brain scans. The associations between VBAC and VBAC volume, functional independence (90-day modified Rankin Scale score of 0–2), and 90-day mortality were assessed using propensity score–adjusted logistic regression. Results— Sixty-four posterior circulation large vessel occlusion patients were included. Twenty-five (39.1%) patients had VBAC, and of these, the median (interquartile range) VBAC volume was 19.8 (6.65–23.4) mm 3 . VBAC was associated with reduced functional independence (OR, 0.19 [95% CI, 0.04–0.78]; P =0.03) and increased mortality (OR, 9.44 [95% CI, 2.43–36.62]; P =0.005). Larger VBAC volumes were a significant predictor of reduced functional independence and increased mortality. Conclusions— VBAC is an independent predictor of outcome in patients undergoing endovascular thrombectomy for posterior circulation large vessel occlusion. Considering the presence of VBAC might improve prognostication and shared treatment decision-making between patients, families, and physicians.

The relationship between vertebrobasilar artery calcification and intracranial atherosclerosis-related occlusion in thrombectomy

“…The probability of VBAC occurring in our study was 36%, which has been identified in 21.0% of elderly community-dwelling people ( 16 ), 39.1% of people presenting posterior circulation large vessel occlusion ( 18 ), and 54.6% in ischemic stroke patients ( 19 ). Factors affecting VBAC are age, hypertension, and diabetes, findings that are consistent with the study by Janine et al ( 16 ).…”

Comparison of symptomatic vertebrobasilar plaques between patients with and without Diabetes Mellitus using computed tomographic angiography and vessel wall magnetic resonance imaging

“…Two studies reported that calcification volumes of the intracranial carotid artery and vertebrobasilar artery were significantly associated with worse outcomes after intra-arterial revascularization therapies. 27 , 28 Yu et al 29 reported that calcification volume on the lesion side was associated with hemorrhagic transformation after intravenous thrombolysis. Therefore, the higher volume of vertebrobasilar artery calcification observed in DM patients may substantially influence the prognostication and treatment decision-making.…”

Staged Endovascular Treatment for Symptomatic Occlusion Originating From the Intracranial Vertebral Arteries in the Early Non-acute Stage

“…In our case series, the technical success rate was 90%, and the mortality was 0% at discharge. Complications occurred in 2 patients: asymptomatic intracranial vertebral artery dissection in one patient and subarachnoid hemorrhage in the other patient (case 6), which might be associated with heavy calcification in the intracranial vertebral artery because a recent study showed that larger vertebrobasilar artery calcification volumes were a significant predictor of reduced technical success and functional independence and increased mortality ( 22 ). Although our results seemed encouraging, it should be emphasized that revascularization of intracranial vertebral artery occlusion in the early non-acute stage is a high-risk procedure.…”