Lee Gi Yun, Yang ChanHyang, Kang Chul-Hoo, Kim Joong Goo, Joo Jin-Deok, Chung You Nam, Huh Ji Soon, Park Jeong Jin, Jeon Jin Pyeong, Rhim Jong-Kook
Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2025 Jul;68(4):383-391. doi: 10.3340/jkns.2024.0104. Epub 2024 Aug 28.
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.
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.
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.
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.
在机械取栓术（MT）治疗椎基底动脉（VB）急性闭塞时，主要考虑采用优势椎动脉（VA）入路。由于有时难以进入优势动脉，我们通过与优势VA入路对比，介绍我们采用非优势VA入路治疗急性VB卒中的经验。
在2014年1月至2022年12月期间诊断为超急性缺血性卒中的2785例患者中，50例VB缺血性卒中患者通过优势、非优势或双侧VA入路接受了再通治疗。我们评估了患者特征和临床过程，突出了各入路的优缺点。
超急性VB缺血性卒中患者以男性为主（72%），平均年龄68.12岁，美国国立卫生研究院卒中量表初始评分平均为17.1。大动脉粥样硬化（48%）和心源性栓塞（36%）是急性卒中治疗组织10172试验分类中的主要病因。取栓术后，45例（90%）患者的最终改良脑梗死溶栓评分达到2b或更高。总之，41例患者通过优势VA治疗，8例患者采用非优势VA入路。然而，两种入路在功能结局或死亡率方面没有统计学上的显著差异。
在MT治疗VB闭塞时，当血管易于进入、稳定或风险较低时，非优势VA入路可能是一种选择，因为无需球囊血管成形术和/或支架置入即可实现再通。
