Purpose

Little is known about catheter-based endovascular treatment of vertebrobasilar artery branch occlusion (VEBABO) in acute ischemic stroke (AIS). Nonetheless, the experience of mechanical thrombectomy (MT) in distal small sized arteries of the anterior circulation seems promising in AIS. In this multicenter study, we report the feasibility, efficacy and safety of MT in VEBABO.

Methods

Retrospective analysis of consecutive AIS patients treated with MT due to VEBABO including posterior and anterior inferior cerebellar artery (PICA, AICA) and superior cerebellar artery (SCA) occlusions at seven tertiary care centers between January 2013 and May 2020. Baseline demographics and angiographic outcomes including recanalization success of the affected cerebellar arteries and procedural complications were recorded. Clinical outcomes were evaluated by the modified Rankin scale (mRS) at discharge and 90 days.

Results

Out of 668 endovascularly treated posterior circulation strokes we identified 16 (0.02%) cases with MT for VEBABO. Most frequently, MT of the SCA was done (13/16, 81%). Most VEBABOs occurred after MT of initial basilar/posterior cerebral artery occlusion (9/16, 56%). In 10/16 (63%) procedures, the affected VEBABO was successfully recanalized. Out of four patients three (75%) with isolated VEBABO had benefited from endovascular therapy. Subarachnoid hemorrhage was observed in 3/16 (19%) procedures. The rate of favorable outcome (mRS ≤2) was 40% at discharge and 47% at 90-day follow-up. Mortality was 13% (2/15).

Conclusion

The use of MT for VEBABO is rare but appears to be feasible and effective; however, the comparatively high rate of procedure-related hemorrhage highlights that the indications for MT in these occlusion sites should be carefully weighed up.

中文翻译：

---

探讨急性缺血性卒中血管内治疗的界限

目的

对急性缺血性卒中 (AIS) 椎基底动脉分支闭塞 (VEBABO) 的基于导管的血管内治疗知之甚少。尽管如此，前循环远端小动脉机械取栓 (MT) 的经验在 AIS 中似乎很有希望。在这项多中心研究中，我们报告了 MT 在 VEBABO 中的可行性、有效性和安全性。

方法

对 2013 年 1 月至 2020 年 5 月期间在七个三级医疗中心因 VEBABO 接受 MT 治疗的连续 AIS 患者的回顾性分析，包括小脑后下动脉和小脑前下动脉（PICA，AICA）和小脑上动脉（SCA）闭塞。基线人口统计学和血管造影结果包括记录受影响小脑动脉的再通成功和手术并发症。在出院和 90 天时通过改良的 Rankin 量表 (mRS) 评估临床结果。

结果

在 668 例接受血管内治疗的后循环卒中中，我们确定了 16 例 (0.02%) 使用 VEBABO 进行 MT 治疗。最常见的是，完成了 SCA 的 MT (13/16, 81%)。大多数 VEBABO 发生在初始基底/大脑后动脉闭塞的 MT 之后（9/16，56%）。在 10/16 (63%) 手术中，受影响的 VEBABO 成功再通。四名患者中有三名 (75%) 的孤立性 VEBABO 受益于血管内治疗。在 3/16 (19%) 的手术中观察到蛛网膜下腔出血。出院时良好结局（mRS ≤ 2）率为 40%，90 天随访时为 47%。死亡率为 13% (2/15)。

结论

对 VEBABO 使用 MT 的情况很少见，但似乎可行且有效；然而，相对较高的手术相关出血率突出表明，应仔细权衡在这些闭塞部位进行 MT 的指征。