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

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 2785 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 score mean of 17.1. Large-artery atherosclerosis (48%) and cardioembolism (36%) were the main etiologic factors in the Trial of Org 10172 in Acute Stroke Treatment classification. After thrombectomy, 45 cases (90%) had final modified thrombolysis in cerebral infarction score of 2b or higher. In summary, 41 patients were treated through the dominant VA, and eight 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.