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. 2024 Jul 21:15910199241264342.
doi: 10.1177/15910199241264342. Online ahead of print.

Rescue extracranial vertebral stenting in tandem occlusions: A preliminary Vietnamese study

Thang Le Minh  1 , Cuong Tran Chi  1 , Nam Nguyen Hoai  2 , Dinh Nguyen Hoang  2 , Giang Nguyen Luu  1 , Huy Nguyen Dao Nhat  1 , Linh Duong Hoang  1 , Tran Nguyen Tran  3 , Luan Tran Minh Bao  2
Affiliations

Rescue extracranial vertebral stenting in tandem occlusions: A preliminary Vietnamese study

Thang Le Minh et al. Interv Neuroradiol. .

Abstract

Background and purpose: The acute vertebrobasilar occlusion associated with the poor prognosis, particularly tandem occlusion. However, few data on the efficacy of the endovascular therapy was indicated in this occlusion. We investigated whether the additional rescue extracranial vertebral stenting improved clinical outcome by modified Rankin scale (mRS) score within 3 months after the procedure.

Methods: This was a retrospective analysis of patients with acute posterior tandem occlusion who were treated with rescue extracranial vertebral stenting between December 2020 and January 2024 at our hospital. Clinical, neuroimaging, procedural, and complication data were collected. Primary outcomes included the rate of good outcomes (mRS ≤ 2) at 3-month follow-up.

Results: Nine patients who underwent rescue extracranial vertebral stenting in posterior circulation tandem occlusions were enrolled in the study. All patients were achieved the successful recanalization (mTICI ≥ 2b). Of Dotter technique in the "distal-to-proximal" approach, Diagnostic-Dotter made up 66.7%. Five patients (55.6%) with good outcome (mRS ≤ 2) at 3 months, and 1 patient (11.1%) underwent suboccipital decompressive craniectomy due to the malignant cerebellar infarction.

Conclusion: Our study suggests that despite the small series with posterior tandem occlusions, the rescue extracranial vertebral stenting could be an important alternative treatment followed by mechanical thrombectomy.

Keywords: Thrombectomy; balloon-expandable stents; extracranial arteries; ischemia; vertebrobasilar insufficiency.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow-chart of patient inclusion in the study.
Figure 2.
Figure 2.
Sample case: a) Extracranial vertebral artery occlusion (red arrow); b) the 5F diagnostic catheter selected through occlusion (blue arrow); c) the coaxial system with an 8F guiding catheter and 5F diagnostic catheter attempted to crossed through the occluded segment (orange arrow); d) Occlusion of top basilar artery (red arrow); e) Intracranial restoration after aspiration; f) Severe stenosis extracranial vertebral artery (blue arrow) and embolic protection devices (EPDs) (green arrow); g) Placement of balloon-expandable stent (Dynamic Renal 5/15; Biotronik AG, Bülach, Switzerland) (orange arrow). The mRS 1 was after 3-month.
Figure 3.
Figure 3.
Distributions of the 3-month mRS in rescue extracranial vertebral stenting patients.
Figure 4.
Figure 4.
Comparison of good outcomes (mRS ≤ 2) at 3 months between relevant studies.
See this image and copyright information in PMC

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