Initial Results of Percutaneous Transluminal Angioplasty/Stenting for Vertebrobasilar Occlusion due to Atherothrombotic Disease during Acute Phase

Natsuhi Sasaki; Hirotoshi Imamura; Shoichi Tani; Hidemitsu Adachi; Ryu Fukumitsu; Tadashi Sunohara; Nobuyuki Fukui; Hiromasa Omura; Tatsumaru Fukuda; Tomoaki Akiyama; Masashi Shigeyasu; Shinji Kajiura; Ryo Horii; Kento Asakura; Nobuyuki Sakai

doi:10.5797/jnet.oa.2020-0062

ORIGINAL ARTICLES

Initial Results of Percutaneous Transluminal Angioplasty/Stenting for Vertebrobasilar Occlusion due to Atherothrombotic Disease during Acute Phase

Natsuhi Sasaki, Hirotoshi Imamura, Shoichi Tani, Hidemitsu Adachi, Ryu Fukumitsu, Tadashi Sunohara, Nobuyuki Fukui, Hiromasa Omura, Tatsumaru Fukuda, Tomoaki Akiyama, Masashi Shigeyasu, Shinji Kajiura, Ryo Horii, Kento Asakura, Nobuyuki Sakai

Author information

Natsuhi Sasaki
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
Hirotoshi Imamura
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Shoichi Tani
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Hidemitsu Adachi
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Ryu Fukumitsu
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Tadashi Sunohara
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Nobuyuki Fukui
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Hiromasa Omura
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Tatsumaru Fukuda
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Tomoaki Akiyama
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Masashi Shigeyasu
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Shinji Kajiura
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Ryo Horii
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Kento Asakura
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Nobuyuki Sakai
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan

Keywords: vertebrobasilar occlusion, atherosclerotic change, ATBI, acute phase, PTA/PTAS

JOURNAL OPEN ACCESS

2021 Volume 15 Issue 5 Pages 295-300

DOI https://doi.org/10.5797/jnet.oa.2020-0062

J-STAGE : jnet 15 6 pp.415-415

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Abstract

Objective: The efficacy and safety of acute percutaneous transluminal angioplasty or stenting (PTA/PTAS) for vertebrobasilar artery occlusion with atherothrombotic brain infarction (ATBI) have not been confirmed despite the resistance to medical therapy alone. There are few reports about this disease and its treatment. Therefore, the treatment outcomes at our hospital were summarized to evaluate the efficacy and safety.

Methods: This was a retrospective study of acute PTA/PTAS for vertebrobasilar artery occlusion due to atherosclerotic change in 19 consecutive patients with a modified Rankin Scale (mRS) score of 0-2 before stroke between March 2010 and December 2018. The factors related to prognosis were investigated. Outcomes were assessed at 90 days of follow-up.

Results: Of 19 patients with acute vertebrobasilar artery occlusion treated by PTA/PTAS, 8 had good outcomes (mRS 0–2) and 11 had poor outcomes (mRS 3–6). There were no differences in the clinical or patient background except for the National Institutes of Health Stroke Scale (NIHSS) score between groups. The good outcome group had a lower NIHSS score than the poor outcome group (median: 9.5 vs 35, p <0.001). The Thrombolysis in Cerebral Ischemia (TICI) 2b-3 group had a slightly more favorable outcome than the TICI0-2a group (p = 0.10). There were no differences in outcome between PTA and PTAS groups (p = 0.65).

Conclusion: Reperfusion of the posterior circulation by PTA/PTAS may be necessary for a good outcome. Although acute stenting must be performed under careful observation, a stent can be placed when recurrence in the early phase is estimated with high probability.

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