A simple classification for the endovascular recanalization of vertebral artery stump syndrome

Abstract

Objective: To share our single-center experience in the treatment of vertebral artery stump syndrome (VASS) and assess the role of the comprehensive classification based on anatomic development, proximal conditions, and distal conditions (PAD).Methods: Data of patients who underwent endovascular thrombectomy (EVT) at Stroke Center of the First Hospital of Jilin University from January 2016 to December 2021 were retrospectively collected. Among patients with acute ischemic stroke in the posterior circulation, those with acute occlusion of the intracranial arteries in the presence of occlusion at the origin of the vertebral artery were selected after confirmation by digital subtraction angiography. Clinical data were summarized and analyzed.Results: We included 13 patients with VASS. The overall surgical recanalization success rate was 76.92%. The successful proximal recanalization rate was 66.67%; the recanalization rates for P1, P2, P3, and P4 types were 100%, 66.7%, 50%, and 66.7%, respectively. The average operation time for A1 and A2 types was 127.5 ± 37.03 (80–180) and 120 min, respectively. The successful distal recanalization rate was 90%—100%, 75%, 100%, and 100% for D1, D2, D3, and D4 types, respectively. Four patients had perioperative complications (incidence rate: 30.77%). Distal embolism occurred in three patients (incidence rate: 23.08%). No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion: EVT is an effective and feasible treatment for VASS, and comprehensive PAD classification can, to a certain extent, help in initially determining the difficulty of surgery and providing guidance for the interventional procedures.