PURPOSE This study aimed to evaluate prognostic parameters associated with favorable clinical prognosis and assess the feasibility and safety of three different treatment strategies in patients with acute intracranial vertebrobasilar artery occlusion (VBAO). METHODS A total of 159 patients with acute VBAO at 3 stroke centers between September 2015 and October 2018 were retrospectively analyzed. Eighty-nine patients underwent mechanical thrombectomy (MT) alone, 43 underwent MT with additional rescue angioplasty, and 27 underwent primary balloon angioplasty (without or with stenting). In patients treated with primary or rescue balloon angioplasty (without or with stenting), a low-dose intra-arterial tirofiban injection was used. The reperfusion status was assessed after the procedure, and the functional outcome was assessed at 90-day follow-up. The baseline characteristics and 90-day prognosis of three different treatment subgroups were comparatively analyzed. RESULTS Overall, successful reperfusion and a favorable outcome were achieved in 96.86% (154/159) and 46.54% (74/159) patients, respectively. The onset to puncture time (461.96 min vs 603.59 min, P = 0.000), procedure time (64.12 min vs 70.47 min, P = 0.007), and onset to reperfusion time (526.08 min vs 674.47 min, P = 0.000) were significantly shorter in patients with favorable outcomes than in those with poor outcomes. Among different endovascular treatment subgroups, no significant differences were found in successful reperfusion and 90-day outcome. Low-dose tirofiban did not increase the risk of symptomatic intracranial hemorrhage and the 90-day mortality in patients with acute VBAO. CONCLUSION Individualized endovascular treatment strategy for selected patients with acute VBAO could achieve satisfactory reperfusion rate and favorable prognosis.

中文翻译：

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急性颅内椎基底动脉阻塞的血管内治疗：多中心回顾性观察研究。

目的本研究旨在评估与良好的临床预后相关的预后参数，并评估三种不同治疗策略对急性颅内椎基底动脉闭塞症（VBAO）的可行性和安全性。方法回顾性分析2015年9月至2018年10月在3个卒中中心的159例急性VBAO患者。仅对89例患者进行了机械血栓切除术（MT），对43例进行了MT并进行了额外的抢救性血管成形术，对27例进行了原发性球囊血管成形术（不采用或采用支架置入术）。在接受原发性或急救性球囊成形术（不使用支架或使用支架术）治疗的患者中，应使用小剂量的替罗非班动脉内注射。手术后评估再灌注状态，并在90天随访时评估功能结局。比较了三个不同治疗亚组的基线特征和90天预后。结果总体而言，分别有96.86％（154/159）和46.54％（74/159）的患者获得了成功的再灌注和良好的结果。穿刺时间（461.96分钟vs 603.59分钟，P = 0.000），手术时间（64.12分钟vs 70.47分钟，P = 0.007）和再灌注时间（526.08 min vs 674.47 min，P = 0.000）明显缩短结果良好的患者要比结果较差的患者高。在不同的血管内治疗亚组之间，成功的再灌注和90天的预后没有发现显着差异。小剂量替罗非班不会增加急性VBAO患者出现症状性颅内出血的风险和90天死亡率。