Characteristics of acute occlusion of the intracranial vertebral artery and endovascular treatment.

To investigate the characteristics of acute occlusion of the intracranial vertebral artery (IVA) and endovascular treatment. Patients with acute IVA occlusion treated with endovascular thrombectomy were prospectively enrolled, and the clinical, treatment and 90-d data were analyzed. Forty-two patients were enrolled, with an age range 34-82 (57 ± 12) years, including 38 (90.48%) male and 4 (9.52%) female patients. Twenty-one (50.0%) patients underwent stent thrombectomy as the preferred recanalization technique, and 36 (85.7%) multiple modes of recanalization. Among the techniques used, balloon angioplasty was performed in 35 (83.3%) patients, stent implantation in 33 (78.6%), stent thrombectomy in 27 (64.3%), and thrombus aspiration in 6 (14.3%). The time from onset to first recanalization of blood vessels was 127-1517 [median 593.5 (326.3, 736.3)] minutes, and the time from puncture to first recanalization was 39-243 [median 67.0 (50.5, 81.3)] minutes. Successful recanalization with the mTICI grade 2b and 3 was present in 40 (95.2%) patients, including mTICI grade 3 in 25 (59.5%) and 2b in 15 (35.7%). Fifteen (35.7%) patients experienced periprocedural complications, including intraprocedural thrombus escape and embolism in 11 (26.2%) patients and symptomatic intracranial hemorrhage in 4 (9.5%). During 90-d follow-up, 16 (38.1%) patients obtained functional independence, 19 (45.2%) achieved good prognosis, and all-cause mortality was present in 9 (21.4%). Compared with patients with good prognosis, those with poor prognosis had significantly (P < 0.05) higher NIHSS scores but lower posterior communicating artery opening rate. Acute IVA occlusion is characterized by intracranial atherosclerosis and progressive stroke and can be successfully recanalized. High baseline NIHSS score and low posterior communicating artery opening rate may be related to poor prognosis.