Endovascular revascularization for nonacute intracranial vertebrobasilar artery occlusion

Objective: To evaluate the technical feasibility, safety and mid-term effect of endovascular revascularization of nonacute intracranial vertebrobasilar artery occlusion. Methods: Consecutive data of patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization, were retrospectively collected and analyzed. Complications and recurrent events during the follow-up period were recorded. The modified Rankin scale (mRS) scores were used to compare the symptoms before and after the procedure. Results: All 27 patients but 1 (96.3%) obtained successful recanalization. After the procedure, 13 patients showed improvements, 11 were stable, and 3 worse. The decline of median mRS scores, which was 4 [interquarter range (IR), 2-5) preoperatively and 3 (IR, 1-5) on discharge, showed significant statistical difference (Z = 3.116, P = 0.002). Five patients had procedural complications, namely 2 dissection, 1 in-stent thrombosis during the operation, 1 thrombus disruption and translocation during the operation and 1 acute reocclusion after operation. During the follow-up period with the median of 21 months, 3 death, 1 stroke and 2 transient ischemic attack occurred. The latest median mRS scores were 1 (IR, 0-3). The ratio of patients with mRS ≤ 2 increased from 25.9% (7/27) before operation to 63.0% (17/27) at the follow up. Seventeen patients received imaging follow-up during the 9 months, with restenosis in 6 and symptom in 3 of them. Subgroup analyses revealed better functional recovery (lower mRS) both in patients with vertebral artery occlusion (Z = 2.111, P = 0.035) and those with basilar artery occlusion (Z = 2.333, P = 0.020). Conclusions: Endovascular revascularization for the nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible, and improves disability recovery. However, the rates of procedural complication and restenosis are high. (authors)