CLINICAL REPORT INTERVENTIONAL Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

SUMMARY: Vertebral artery recanalization in symptomatic stenosis/occlusion remains controversial, as no definite evidence exists regarding this topic. There are only a few reports regarding the feasibility and safety of recanalization in the first segment of the vertebral artery with atherosclerotic vertebral ostial occlusion. We report our experience treating first segment occlusion in 8 patients and present a balloon protection technique used to reduce the thromboembolic burden during the stent placement procedure. The outcome at 3 months showed an mRS2 except for a patient with a poor initial status with basilar artery occlusion. Revascularization of a rather long first segment occlusion is technically feasible and can be safely performed by use of embolic protection methods. ABBREVIATIONS: BA basilar artery; DUS Doppler ultrasonography; NIHSSo National Institutes of Health Stroke Scale on admission; PcomA posterior communicating artery; VA vertebral artery; V1 first segment of the vertebral artery. Atherosclerotic lesions of the vertebral artery (VA) origin are apotential cause of posterior circulation ischemia, which has approximately a 20 % to 50 % risk for vertebrobasilar TIA or stroke.1 The VA ostium is known to be the most common site for atherosclerosis of the posterior circulation.2 Patients with symp-tomatic severe ( 70%) ostial VA stenosis face an 11%annual risk for recurrent stroke or TIA while receiving medical treatment.3 Early understanding of the stroke mechanism of VA ostial le