Cerebral revascularization of symptomatic severe vertebro ⁃ basilar artery steno ⁃ occlusion with posterior circulation ischemic stroke

Abstract

Objective To explore the efficacy and safety of cerebral revascularization treatment for the posterior circulation ischemic stroke with chronic vertebro ⁃ basilar artery steno ⁃ occlusion. Methods From January 2018 to January 2021, 11 patients with posterior circulation ischemic stroke by chronic vertebro⁃basilar artery steno⁃occlusion were diagnosed and treated in Tianjin Huanhu Hospital. We utilized MRI to locate the infarct, CTA to assess the steno⁃occlusive site and the stenosis rate, and DSA to evaluate the collateral compensation. These patients were treated by using occipital artery (OA)⁃vertebral artery (VA) bypass, external carotid artery (ECA) ⁃ VA bypass with radial artery (RA) graft, OA ⁃ posterior inferior cerebellar artery (PICA)/anterior inferior cerebellar artery (AICA) bypass and superficial temporal artery (STA)⁃posterior cerebral artery (PCA)/superior cerebellar artery (SCA) bypass. The prognosis was assessed through modified Rankin Scale (mRS). Results The steno⁃occlusive sites confirmed by CTA were located at basilar artery(BA, 2/11), bilateral vertebr ⁃ basilar artery as tander lesions (1/11), intracranial and extracranial segments of bilateral VA (2/11 and 11/11), unilateral intracranial segment of VA with contralateral extracranial segment of VA (4/11), initial segment of unilateral VA with tenderness of contralatieral VA (1/11). Collateral patterns confirmed by DSA included posterior communicating artery (PCoA, 7/11), cerebellar pial collateral (5/11; among PICA, AICA and SCA), ascending cervical artery (AA, 4/11), cerebral pial collateral [middle cerebral artery (MCA)⁃PCA, 3/11] and anterior spinal artery (ASA, 1/11). All the 11 patients underwent bypass operation successfully. Imaging [indoleocyanine green angiography (ICGA), DSA and CTA] suggested bypass vascular patency. Two patients suffered lung infection postoperatively, one patient was suspected with intracranial infection, and all the patients got better after antibiotic treatment. The median mRS score was 1. The mean follow⁃up time was 8 months. Nine patients had good prognosis at discharge (mRS score 0-1), 2 cases had a medial prognosis (mRS score 2-3). Conclusions Cerebral revascularization treatment of chronic symptomatic severe vertebro ⁃ basilar artery steno⁃occlusive with posterior circulation ischemic stroke is effective, safe, and feasible.

doi：10.3969/j.issn.1672⁃6731.2021.07.005