Endovascular therapeutic strategies for acute posterior cerebral large artery occlusion due to occlusion of vertebral artery origin

Objective: To investigate the endovascular therapeutic strategies for acute posterior cerebral large artery occlusion due to occlusion of vertebral artery (VA) origin, and disscuss the clinical effect and safety. Methods: This study retrospectively analyzed eight patients with acute posterior ischemic stroke due to occlusion of VA origin who underwent endovascular therapy from June 2014 to July 2017. Using the common path through femoral artery, femoral artery and brachial artery, the intervertebral artery endarterectomy combined with the Solitaire stent was performed to open the blood vessel. The evaluation contents included endovascular therapeutic strategies, TIMI grade to confirm the reconstruction of blood flow, the early neurologic improvement of National Institutes of Health Stroke Scale (NIHSS) on admission and discharge and the functional score on the modified Rankin scale (mRS) at 90 d. Results: All patients had different levels of consciousness disorder (sleepiness to lethargy of 3 cases and light coma to deep coma of 5 cases) . The proximal basilar artery (BA) was occluded in 1 patient, middle BA in 4 cases, tip of BA in 3 cases and occlusion of VA origin was found at left (3 cases) and right (5 cases) . Six patients were recanalized successfully. The endovascular therapeutic strategies included transfemoral artery pathway (5 cases) , transfemoral and transbrachial artery pathway (2 cases) and combined endarterectomy of vertebral artery (1 case) . The scores of the NIHSS were decreased (30.75±8.21 on admission, vs. 11.88±7.6 at discharge; t=3.297, P=0.013) . Two patients died, however, 4 patients walked at discharge. Five patients had good functional independence (90 d modified Rankin score of 0 to 2) . Conclusions: Multimode endovascular methods in treatment of patients with acute posterior cerebral infarction due to occlusion of VA origin can improve arterial reperfusion, early neurologic recovery, and functional outcome. Key words: Endovascular therapy; Acute stroke; Posterior circulation; Occlusion of vertebral artery origin