Angioplasty and stenting for symptomatic nonacute vertebrobasilar artery occlusion

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  To evaluate the technical feasibility, safety and treatment effect of angioplasty and stenting for symptomatic nonacute vertebrobasilar artery occlusion.13 patients (11 men, 2 women; median age, 61 years: range, 39-75 years) with symptomatic nonacute vertebrobasilar artery occlusions were treated, and complications were recorded.Treatment effect was evaluated by comparing the mRS (modified Rankin Scale) scores and bloodstream TIMI (thrombolysis in myocardial infarction) scores for all patients at preoperation, postoperation and follow-up.Median TIMI was improved from 1 at preoperation to 3 at postoperation (P ≤ 0.05) and Recanalization was achieved in 11 of the 13 patients (84.6%).24h after procedure, 1 patient s symptom was stable, 10 improved, and 2 worse.Three patients (23.3%) had periprocedural complications.There was no death occurred in perioperative period.3 months after procedure, the median mRS deduced from 5 at preoperation to 3 (P ≤ 0.05), but 1 patient died of systemic complications.The latest follow-up showed that good outcome (mRS,0-2) rate was 53.8% (7/13) in all the patients and 70% (7/10) in the alive, but another 2 patients died.Subgroup analyses revealed that compared with their respective preoperative mRS, the three-month mRS reduced significantly only in VAO group (P ≤ 0.05) and there was no significant difference in BAO group (P ≥ 0.05).In addition, significant difference was found in the rate of good outcome at the latest follow-up (P ≤ 0.05) between BAO group and VAO group.The results suggest that angioplasty and stenting for the recanalization of the nonacute vertebrobasilar artery occlusion is technically feasible.Patients with pure vertebral artery occlusion seem to develope a better outcome than those with occlusion involving basilar artery.However, due to the high rate of complication and complexity of the operation, the indication for the treatment should be strict and the operation should be carried out in some centres with experienced doctors.
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