Peng Gao1, Yabing Wang2, Yan Ma2, Qi Yang3, Haiqing Song4, Yanfei Chen2, Liqun Jiao5, Adnan I Qureshi6. 1. Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, 100053 Beijing, China. 2. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China. 3. Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China. 4. Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China. 5. Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, 100053 Beijing, China. Electronic address: liqunjiao@sina.cn. 6. Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
Abstract
OBJECTIVE: The optimal treatment of chronic symptomatic total occlusion of the intracranial vertebral artery (ICVA) remains undefined. We report a single-center experience of endovascular recanalization for patients with chronic symptomatic ICVA occlusion who were refractory to medical therapy. METHODS: From Jan 2009 to Jan 2017, we retrospectively reviewed 14 consecutive patients presenting with recurrent symptoms attributed to the chronic ICVA occlusion. We searched previous literature using PubMed databases during the same period as comparison. RESULTS: Eleven patients out of 14 presented initial symptoms to intervention less than 90days. The occlusion course was extrapolated on simultaneous two-vessel injection angiography or high-resolution MR imaging (HRMRI) in 13 cases. Nine patients had the occlusion beyond the origin of posterior inferior cerebellar artery (PICA) and 5 had the occlusion proximal to the PICA origin. The technical success rate of recanalization was 85.7% (12/14). Two patients (14.3%, 2/14) had peri-procedural complications: 1 developed TIA and 1 presented with perforator occlusion syndrome. Using the keyword-based search, we identified 6 studies at the same period. A total of 34 patients underwent recanalization with the successful recanalization rate at 94.1%, peri-procedural complication rate at 17.6% and mortality at 2.9%, respectively. CONCLUSION: Our single-center study illustrated the feasibility and safety of ICVA recanalization. Great care should be taken as revascularization is of high risk. When patient selection, occlusion course and stage as well as neuroimaging evaluation are considered, endovascular recanalization may be a useful therapeutic modality.
OBJECTIVE: The optimal treatment of chronic symptomatic total occlusion of the intracranial vertebral artery (ICVA) remains undefined. We report a single-center experience of endovascular recanalization for patients with chronic symptomatic ICVA occlusion who were refractory to medical therapy. METHODS: From Jan 2009 to Jan 2017, we retrospectively reviewed 14 consecutive patients presenting with recurrent symptoms attributed to the chronic ICVA occlusion. We searched previous literature using PubMed databases during the same period as comparison. RESULTS: Eleven patients out of 14 presented initial symptoms to intervention less than 90days. The occlusion course was extrapolated on simultaneous two-vessel injection angiography or high-resolution MR imaging (HRMRI) in 13 cases. Nine patients had the occlusion beyond the origin of posterior inferior cerebellar artery (PICA) and 5 had the occlusion proximal to the PICA origin. The technical success rate of recanalization was 85.7% (12/14). Two patients (14.3%, 2/14) had peri-procedural complications: 1 developed TIA and 1 presented with perforator occlusion syndrome. Using the keyword-based search, we identified 6 studies at the same period. A total of 34 patients underwent recanalization with the successful recanalization rate at 94.1%, peri-procedural complication rate at 17.6% and mortality at 2.9%, respectively. CONCLUSION: Our single-center study illustrated the feasibility and safety of ICVA recanalization. Great care should be taken as revascularization is of high risk. When patient selection, occlusion course and stage as well as neuroimaging evaluation are considered, endovascular recanalization may be a useful therapeutic modality.
Authors: Nso Nso; Mahmoud Nassar; Mia Trimingham; Yolanda Mbome; Anthony Lyonga Ngonge; Solomon O Badejoko; Shahzad Akbar; Atika Azhar; Sofia Lakhdar; Muhammad Ghallab; Laura M Guzman Perez; Vincent Rizzo; Most Sirajum Munira Journal: Cureus Date: 2022-05-05