Retrograde recanalization for vertebral artery occlusion without a stump (REVANS): a technical note

Area of Science:

• Interventional Neurology
• Vascular Surgery
• Endovascular Therapy

Background:

• Vertebral artery occlusion (VAO) management is challenging, especially in cases lacking a stump.
• Existing endovascular strategies for VAO without a stump are not well-defined.
• Case reports indicate potential safety and feasibility of endovascular recanalization for such cases.

Purpose of the Study:

• To describe the REVASCULAR Access Navigation Strategy (REVANS) technique for endovascular recanalization.
• To present the application of the REVANS technique in patients with VAO and no visible stump.
• To evaluate the potential of REVANS as a management strategy for symptomatic non-acute VAO without a stump.

Main Methods:

• Technical description of the REVANS technique.
• Application of the REVANS technique in a specific patient cohort with VAO lacking a stump.
• Utilizing cervical collateral vessels for retrograde access to the occluded vertebral artery segment.

Main Results:

• The REVANS technique was successfully applied in patients with VAO without a stump.
• The approach demonstrated feasibility in accessing and recanalizing occluded vertebral artery segments.
• Cervical collateral vessels were effectively leveraged for retrograde recanalization.

Conclusions:

• The REVANS technique is a promising option for managing symptomatic non-acute VAO without a visible stump.
• This endovascular approach offers potential benefits for improving patient outcomes in challenging VAO cases.
• Further investigation into the REVANS technique may expand endovascular treatment options for VAO.