Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Department of Interventional Neurology, Shandong Qianfoshan Hospital, Jinan, Shandong, China.
J Neurointerv Surg. 2022 Feb;14(2):133-137. doi: 10.1136/neurintsurg-2020-017213. Epub 2021 Mar 4.
There is no consensus on the optimal treatment of non-acute basilar artery occlusion (BAO), and endovascular recanalization still poses a therapeutic challenge for these patients. We report a multicenter clinical experience of endovascular recanalization for symptomatic non-acute BAO and propose an angiographic grouping to determine which patient subgroup most benefits from this treatment.
Forty-two patients with non-acute BAO with progressive or recurrent vertebrobasilar ischemic symptoms who underwent endovascular recanalization were retrospectively analyzed from January 2015 to December 2019. These patients were classified into three subtypes based on their occlusion length and distal collateral reconstruction on angiograms. The rates of technical success, periprocedural complications and outcome, any stroke or death within 1 month, and follow-up data were examined.
The success rate of endovascular recanalization was 76.2% (32/42). The rate of periprocedural complications was 14.3% (6/42). In the three subgroups (types I-III) the success rates of endovascular recanalization were reduced (90.0%, 71.4% and 50%, respectively, p=0.023), while the overall rates of periprocedural complications were increased (5.0%, 14.3% and 37.5%, respectively, p=0.034). Type I lesions, with short-segment occlusions and good distal BA collateral reconstruction, showed favorable responses to endovascular recanalization. The median follow-up time was 1 year (IQR 11.0-19.5 months), with any stroke or death during follow-up at a rate of 7.9%.
Endovascular recanalization can be safe and feasible for reasonably selected patients with non-acute BAO, especially type I lesions, and offers an alternative choice for those with progressive or recurrent vertebrobasilar ischemic symptoms despite aggressive medical therapy.
对于非急性基底动脉闭塞（BAO），目前尚无最佳治疗方法，血管内再通治疗对这些患者仍然是一个治疗挑战。我们报告了多中心的血管内再通治疗症状性非急性 BAO 的临床经验，并提出了一种血管造影分组方法，以确定哪些亚组患者最受益于这种治疗。
回顾性分析了 2015 年 1 月至 2019 年 12 月期间接受血管内再通治疗的 42 例非急性 BAO 伴进展性或复发性椎基底动脉缺血症状患者。根据闭塞长度和血管造影远端侧支重建情况，将这些患者分为三组。检查技术成功率、围手术期并发症和结局、1 个月内任何卒中和死亡、以及随访数据。
血管内再通成功率为 76.2%（32/42）。围手术期并发症发生率为 14.3%（6/42）。在三组（I-III 型）中，血管内再通成功率降低（分别为 90.0%、71.4%和 50%，p=0.023），而围手术期并发症的总发生率升高（分别为 5.0%、14.3%和 37.5%，p=0.034）。I 型病变，闭塞段较短，远端 BA 侧支重建良好，对血管内再通反应良好。中位随访时间为 1 年（IQR 11.0-19.5 个月），随访期间任何卒中和死亡的发生率为 7.9%。
血管内再通治疗对于合理选择的非急性 BAO 患者，特别是 I 型病变患者，是安全可行的，为那些尽管进行了积极的药物治疗但仍有进展性或复发性椎基底动脉缺血症状的患者提供了另一种选择。
