Endovascular Recanalization for Chronic Symptomatic Intracranial Vertebral Artery Total Occlusion

Purpose. The outcome of recanalization in patients with chronic symptomatic intracranial vertebral artery (ICVA) total occlusion is poor. This paper reports the technical feasibility and long-term outcome of ICVA stenting in patients with chronic symptomatic total occlusion. Methods. Retrospective review of our prospectively maintained intracranial intervention database to identify patients with symptomatic total occlusion of ICVA with revascularization attempted >1 month after index ischemic event. Results. Eight patients (mean age 58 years) were identified. One had stroke and 7 had recurrent transient ischemic attacks. Four had bilateral ICVA total occlusion and 4 had unilateral ICVA total occlusion with severe stenosis contralaterally. Seven of 8 patients underwent endovascular recanalization, which was achieved in 6. Periprocedural complications included cerebellum hemorrhage, arterial dissection, perforation, and subacute in-stent thrombosis which occurred in 3 patients. One patient died of cerebellum hemorrhage. The other patients improved clinically after endovascular therapy. Conclusions. Stent-supported recanalization of ICVA total occlusion is technically feasible, and may become a viable treatment option in selected patients. 1. Introduction Intracranial vertebral artery (ICVA) is a common site of atherosclerosis, often involved bilaterally [1, 2]. Patients with bilateral ICVA occlusion usually present with recurrent attacks of dizziness, visual disturbance, and ataxia, and some may be disabled by infarction of regions supplied by the posterior circulation [2]. While limited leptomeningeal collaterals may maintain baseline perfusion for most cases, they usually failed to provide sufficient blood flow during periods of increased oxygen demand, resulting in lifestyle-limiting symptoms. Development of endovascular intervention and improved operator experience have rendered angioplasty and stenting a potential treatment option for these patients but its safety and efficacy remains uncertain [3–5]. The incidence of the chronic ICVA occlusive disease in the Chinese patients may overweigh that of Caucasian patients [6]. To evaluate the feasibility and efficacy of the endovascular therapy for them is urgent. In this paper, we illustrated the feasibility of elective (at least 1 month after ischemic event) endovascular recanalization for symptomatic ICVA total occlusion and their long-term outcome. 2. Methods 2.1. Patient Selection and Data Collection We retrospectively reviewed our prospectively maintained neurointerventional database from March 2007