Mechanical Thrombectomy for Hyperacute Vertebrobasilar Ischemic Stroke via Nondominant Vertebral Artery : Clinical Experience and Considerations

¹Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
²Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
³Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Nursing, Jeju, Korea
⁴Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
⁵Department of Neurology, Konkuk University Medical Center, Seoul, Korea
⁶Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea

Correspondence

Jong-Kook Rhim ,Tel: +82-64-717-1620, Fax: +82-64-717-1656, Email: nsrhim@gmail.com

Received: May 23, 2024; Revised: August 15, 2024 Accepted: August 22, 2024. Published online: August 28, 2024.

ABSTRACT

Objective
: The dominant vertebral artery (VA) approach is primarily considered in mechanical thrombectomy (MT) for acute occlusion of the vertebrobasilar (VB) artery. As accessing the dominant artery is sometimes difficult, we present our experience treating acute VB stroke via a nondominant VA approach through a comparison with the dominant VA approach.
Methods
: Among 2,785 patients diagnosed with hyperacute ischemic stroke between January 2014 and December 2022, 50 patients with VB ischemic stroke underwent recanalization therapy through either dominant, nondominant, or bilateral VA approach. We evaluated patient characteristics and clinical course, highlighting the pros and cons of the access routes.
Results
: The patients with hyperacute VB ischemic stroke were predominantly male (72%), with a mean age of 68.12 years and an initial National Institutes of Health Stroke Scale (NIHSS) score mean of 17.1. Large-artery atherosclerosis (LAA, 48%) and cardio-embolism (CE, 36%) were the main etiologic factors in the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. After thrombectomy, 45 (90%) cases had final modified thrombolysis in cerebral infarction (mTICI) score of 2b or higher. In summary, 41 patients were treated through the dominant VA, and 8 patients underwent the nondominant VA approach. However, there was no statistically significant difference in functional outcome or mortality between the two approaches.
Conclusion
: In MT for VB occlusions, nondominant VA approach may be an option in situations when the vessel is accessible, stable, or less risky, as recanalization can be achieved without rescue balloon angioplasty and/or stenting.

Key Words: Ischemic stroke · Thrombectomy · Vertebral artery · Vertebrobasilar ischemia