Best Revascularisation Approach for Posterior Circulation Strokes With Isolated Vertebral Artery Occlusions

Centre Hospitalier Universitaire Vaudois682 enrolled

Overview

Isolated vertebral artery occlusions (VAO) account for approximately one third of posterior circulation occlusions, but have been given the least attention among posterior circulation strokes. If the two recent ATTENTION and BAOCHE randomized clinical trials have proven the superiority of endovascular thrombectomy (EVT) in basilar artery occlusions, data on the effectiveness and harm of acute revascularization treatment on isolated VAO is scarce. We aim to investigate the impact of acute recanalisation treatments in acute ischemic stroke patients with isolated VAO. In the absence of RCT, observational data with appropriate statistical methods may give indications on benefits and harms of treating neglected stroke situations like acute vertebral occlusion. Results may also lay the basis for prospective studies, such as randomized clinical trials.

Study Type

OBSERVATIONAL

Enrollment

682

Conditions

Ischemic Stroke Vertebral Artery Ischemia Arterial Occlusive Diseases Vertebrobasilar Insufficiency

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion criteria: * Acute ischemic stroke limited to the posterior circulation * Presence of uni- or bilateral VAO (intracranial and/or extracranial) on at least one initial imaging study (CTA, MRA, DSA) * IVT, EVT or bridging-treated stroke patients between 01.01.2003 and 31.12.2021 * ≥ 18 years old Exclusion criteria * Extension of the occlusion into the basilar artery * Presence of a more distal occlusion in the pc (tandem occlusion/multilevel poster circulation occlusions) * Previously known chronic occlusion of the any segment of the vertebral artery/arteries * Local ethical/legal conditions in participating center not fulfilled

Outcomes

Primary Outcomes

3-month modified Rankin scale

3-month functional outcome, \[range: 0-6, 0= no symptoms, 6=death\]

Time frame: 90 days

Secondary Outcomes

Symptomatic intracerebral haemorrhage (sICH)

Any hemorrhagic transformation temporally related to any worsening in neurological condition. \[yes/no\]

Time frame: 7 days

EVT procedural complications

Any complication attributed to the procedure (vessel perforation, vasospasm, dissection, Subarachnoid haemorrhage (SAH)/Intracerebral haemorrhage (ICH), device detachment/misplacement, embolization to new territory, access-site complications, early reocclusion, other)

Time frame: During EVT procedure or peri-procedural

24-hour NIHSS

NIH Stroke Scale/Score (NIHSS). Quantifies stroke severity based on weighted clinical evaluation findings at 24h. \[0-42, 0= no deficit, 42=maximum stroke severity\]

Time frame: 24 hours

Early neurological deterioration (ENDi)

Early neurological deterioration of ischemic origin (ENDi) is defined as an increase in National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours. \[yes/no\]

Time frame: 24 hours

Cerebrovascular ischemic recurrences

Any ischemic stroke or transient ischemic attack recurrence \[yes/no\]

Time frame: 90 days

24h and 3month mortality

Mortality at 24h and 3 months

Time frame: 24h and 90 days

Vessel recanalisation on follow up-imaging

Vessel recanalisation at follow-up imaging (0= no recanalisation, 1= partial recanalisation 50-99%, 2=full recanalisation, 3= initially not occluded)

Time frame: 48 hours