Multimodal Therapy for Non-Superacute Vertebral Basilar Artery Occlusion

Abstract

Objective: The aim of this study was to evaluate the feasibility and safety of multimodal therapy for patients with non-superacute vertebral basilar artery occlusion.

Method: We performed a retrospective analysis of multimodal therapy for patients with vertebral basilar artery occlusion. All patients who were beyond the time window to receive intravenous thrombolysis and who had deterioration of symptoms after drug treatment received small-balloon dilatation of the occlusive artery to estimate vascular occlusion aetiology. Thrombectomy with a Solitaire AB system was applied to the thrombus, and angioplasty with intracranial stents was used to treat stenosis. During the 3-month follow-up, National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were recorded regularly.

Results: We included 12 patients with a mean age of 60.4 (SD: 12.9) years. The average score on the NIHSS was 16.6 (SD: 11.6), and the average time from onset to admission was 95 h (SD: 121). The arteries were recanalized for all patients, but the degree of residual stenosis in the parent artery was 17.5% (SD: 20.1). During the follow-up period, one patient died of pulmonary haemorrhage and infection, and another patient died from haemorrhage related to high perfusion. After 3 months of follow-up, the 10 surviving patients showed an average NIHSS score of 7.9 (SD: 8.7) and an average mRS score below 2 (1.3 ± 1.4).

Conclusion: For patients with posterior circulation stroke due to basilar artery or vertebral artery occlusion who present to the hospital 6 h after symptom onset and who exhibit deterioration of symptoms after drug treatment, multimodal recanalization of the occluded artery may be a feasible and safe therapy.

Keywords: Acute stroke; Endovascular treatment; Recanalization; Thrombectomy; Vertebrobasilar insufficiency.

Fig. 1

One case of basilar artery occlusion recanalization. a Distal basilar artery occlusion before operation. b After being treated with thrombectomy.

Fig. 2

Another case with double intracranial vertebral artery occlusion. a Intracranial left vertebral artery occlusion. b, c Intracranial right vertebral artery occlusion (after posterior inferior cerebellar artery); basilar artery, contralateral vertebral artery and contralateral posterior inferior cerebellar artery were compensated by anterior spinal artery. d Normal blood flow after thrombectomy stent implantation during the operation and thrombus could be seen. e Normal blood flow and desirable angioplasty after thrombus extraction by stents. f Submitted histopathologic slide indicates mixed thrombus.

Fig. 3

Imaging of case 12. a Brain computed tomography before operation. b Right vertebral artery occlusion before operation. c Basilar artery occlusion before operation. d-g Revascularization of basilar artery after operation. h Magnetic resonance imaging before hospital discharge.