Endovascular Recanalization with Distal Protection for Chronic Vertebrobasilar Occlusions

Overview

This retrospective study evaluated the safety and efficacy of endovascular recanalization using distal protection with a stent retriever in eight patients with symptomatic non-acute occlusion of the intracranial vertebrobasilar artery (VBA). The technique demonstrated successful recanalization with reduced procedural complications in a challenging patient population refractory to medical therapy.

Background

Atherosclerotic occlusion of the intracranial vertebral and basilar arteries is a common cause of posterior circulation strokes, which account for approximately 20% of all strokes. Patients with chronic occlusions often continue to experience transient ischemic attacks (TIAs) or strokes despite aggressive medical management. Endovascular recanalization in this vascular territory is technically challenging due to risks such as perforator stroke, dissection, thrombosis, and distal embolism. The distal protection with stent retriever technique has been proposed to reduce these complications during intervention.

Data Highlights

Key Findings

• All eight patients with symptomatic non-acute VBA occlusion underwent successful endovascular recanalization using distal protection with a stent retriever.
• The technique allowed safe passage through occluded segments and facilitated thrombus removal, minimizing distal embolization.
• Antegrade blood flow was restored with modified thrombolysis in cerebral infarction (mTICI) scores ≥ 2b in all cases.
• No major periprocedural ischemic or hemorrhagic complications were reported, indicating a favorable safety profile.
• Six-month follow-up angiography was performed to monitor for restenosis, defined as ≥ 50% stenosis or ≥ 20% luminal loss.

Clinical Implications

Endovascular recanalization with distal protection using a stent retriever appears to be a feasible and safe therapeutic option for patients with symptomatic chronic occlusions of the intracranial vertebrobasilar artery refractory to medical therapy. This approach may reduce procedural complications such as distal embolism and improve recanalization success rates. Careful patient selection and perioperative management remain essential.

Conclusion

The distal protection stent retriever technique for endovascular recanalization of symptomatic non-acute vertebrobasilar artery occlusions demonstrates promising safety and efficacy. Further larger studies are warranted to confirm these findings and optimize procedural protocols.

References

1. Wang et al. 2024 -- Endovascular Recanalization with Distal Protection for Symptomatic Chronic Occlusions of the Vertebrobasilar Artery