Endovascular therapy for acute vertebrobasilar occlusion underlying atherosclerosis: A single institution experience

To compare the safety and efficacy of endovascular therapy in acute ischemic stroke (AIS) caused by large artery occlusion (LAO) in the posterior circulation with or without intracranial atherosclerosis (ICAS).

The study enrolled patients who underwent endovascular therapy for AIS caused by posterior circulation LAO. Inclusion criteria for endovascular therapy of vertebrobasilar occlusion were as follows: (1) CTA or MRA confirmed acute vertebrobasilar occlusion; (2) baseline NIHSS score ≥2; (3) premorbid mRS score ≤2; (4) onset or last known well time to puncture within 24 h; (5) pc-ASPECTS ≥6. Outcomes were compared between the ICAS group and the non-ICAS group.

A total of 67 patients were recruited in this study, of which 35 (52.2%) had underlying ICAS, while 32 (47.8%) did not. Rescue therapies were more commonly performed in the ICAS group (82.9% vs. 34.4%; p = 0.000). The proportion of favorable outcome at 90 days was higher in the ICAS group than in the non-ICAS group (71.4% vs. 46.9%; p = 0.041). There was no significant difference in symptomatic ICH (2.9% vs. 6.3%, p = 0.603) or death within 90 days (22.9% vs. 37.5%, p = 0.191) between the two groups. The baseline GCS score (OR 1.281, 95% CI: 1.085-1.513; p = 0.004) and PMI (OR 0.402, 95% CI: 0.233 to 0.693; p = 0.001) were independently associated with favorable outcome at 90 days.

Endovascular therapy with stent-retriever thrombectomy followed by rescue treatment can achieve high rates of successful revascularization and favorable outcome in the treatment of AIS caused by posterior circulation LAO.