Li Yun-Peng, Zhou Zhi-Long, Zhang Yang, Wang Li-Na, Wu Li-Heng, Zhu Liang-Fu, Li Tian-Xiao, Gao Bulang
Central Intensive Care Unit, Henan Provincial People's Hospital, Henan University, 7 Weiwu Road, Zhengzhou, 450000, Henan Province, China.
Stroke Center, Henan Provincial People's Hospital, Henan University, 7 Weiwu Road, Zhengzhou, 450000, Henan Province, China.
Sci Rep. 2025 Jul 4;15(1):23845. doi: 10.1038/s41598-025-08655-2.
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.
探讨颅内椎动脉（IVA）急性闭塞的特点及血管内治疗情况。前瞻性纳入接受血管内血栓切除术治疗的急性IVA闭塞患者，并分析其临床、治疗及90天数据。共纳入42例患者，年龄范围34 - 82（57±12）岁，其中男性38例（90.48%），女性4例（9.52%）。21例（50.0%）患者首选支架取栓术作为再通技术，36例（85.7%）采用多种再通方式。在所使用的技术中，35例（83.3%）患者行球囊血管成形术，33例（78.6%）行支架植入术，27例（64.3%）行支架取栓术，6例（14.3%）行血栓抽吸术。从发病到首次血管再通的时间为127 - 1517[中位数593.5（326.3，736.3）]分钟，从穿刺到首次再通的时间为39 - 243[中位数67.0（50.5，81.3）]分钟。40例（95.2%）患者实现mTICI 2b和3级成功再通，其中25例（59.5%）为mTICI 3级，15例（35.7%）为2b级。15例（35.7%）患者发生围手术期并发症，包括11例（26.2%）患者术中血栓逃逸和栓塞，4例（9.5%）患者发生有症状颅内出血。在90天随访期间，16例（38.1%）患者获得功能独立，19例（45.2%）患者预后良好，9例（21.4%）患者全因死亡。与预后良好的患者相比，预后不良的患者美国国立卫生研究院卒中量表（NIHSS）评分显著更高（P < 0.05），但后交通动脉开放率更低。急性IVA闭塞以颅内动脉粥样硬化和进展性卒中为特征，可成功再通。较高的基线NIHSS评分和较低的后交通动脉开放率可能与预后不良有关。
