AUTHOR=Zhou ZhiLong , Li TianXiao , Zhu LiangFu , Wu LiHeng , Guan Min , Ma ZhenKai , Liu YangHui , Qin Jin , Gao BuLang 

TITLE=Endovascular recanalization of symptomatic non-acute occlusion of the vertebrobasilar artery

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1125244

DOI=10.3389/fneur.2023.1125244

ISSN=1664-2295

ABSTRACT=Purpose: To investigate the safety, effect, and risk factors of endovascular recanalization of symptomatic non-acute occlusion of vertebrobasilar artery (SNOVA).
Materials and methods: Patients with SNOVA were retrospectively enrolled and treated with endovascular recanalization. The clinical data, endovascular treatment, peri-procedural complications, and follow-up outcomes were analyzed.
Results: Eighty-eight patients were enrolled, with an interval to recanalization of 2-89 days (median 23) and an mRS of 2-5 (mean 3.3 ± 1.1). Occlusion was in the intracranial vertebral artery in 68 (77.27%) patients and basilar artery in 20 (22.73%), with an occlusion length of 4.5-43.7 mm (mean 18.3 ± 8.8). Endovascular recanalization was successful in 81 (92.0%) patients. Post-dilatation was performed in 23 (28.4%) patients. After stenting, the residual stenosis was 10%-40% (mean 20.2% ± 7.6%). Periprocedural complications occurred in 17 (19.3%) patients, with a mortality rate of 5.7%. Seventy-nine (95.18%) patients underwent follow-up 5-29 (mean 16.9 ± 5.5) months later, with an mRS score of 0-6 (median 1 and IQR 1) at follow-up, significantly (P<0.0001) better than that at discharge. Stroke occurred in nine patients (11.4%) at one year. In-stent restenosis occurred in 19 (25.33%) patients. Significant (P<0.05) independent risk factors were blunt occlusion for successful recanalization, duration to recanalization and blunt occlusion for peri-procedural complications, and post-dilatation for both in-stent restenosis and 1-year stroke or death events. 
Conclusion: Endovascular recanalization of symptomatic non-acute occlusion of vertebrobasilar artery is feasible even for a long occlusion segment, with a high recanalization rate, high safety, and good prognosis.