Abstract|Stroke 2| Volume 357, SUPPLEMENT 1, e102-e103, October 15, 2015

Recanalization of chronic neurovascular arterial occlusion with acute clinical deterioration: Endovascular treatment and clinical outcome

      Purpose: To evaluate the indications for and results of the endovascular reconstruction of extra- and intracranial arteries after subacute and chronic occlusion.
      Methods and materials: A retrospective analysis of clinical and angiographic data of 35 patients who underwent this treatment was performed. All endovascular procedures were carried out under general anaesthesia with dual platelet inhibition. An individual combination of balloon angioplasty and stent deployment was used.
      Results: A total of 35 patients and 36 occlusions treated between 2007 and 2014 were evaluated. Treatment indications were acute clinical symptoms in 21/35 (60%) patients. Target vessels were ICA (n = 5), MCA (n = 2), VA (n = 13), BA (n = 7) or a combination thereof (n = 9). The attempted vessel reconstruction was achieved in 32/36 (88.8%) procedures. Clinical improvement was confirmed in 30 patients (83.3%), two of them despite failed attempt. At follow-up, permanent neurological deficit was encountered in 16 patients. Four patients died, one as a consequence to the procedure.
      Conclusion: Haemodynamic compromise of the dependent circulation is a possible reason for the endovascular reconstruction of extra- and intracranial vessels in the status of subacute or chronic occlusion. The procedure can be quite demanding (e.g., for basilar and MCA reconstruction). Long-term dual anti-aggregation, angiographic follow-up and treatment of in-stent re-stenoses are part of the concept. Clinical results reach from considerable improvement to major morbidity and procedural mortality.