To investigate interventional recanalization strategies in patients with symptomatic vertebral artery ostial occlusion.

Seventeen consecutive patients with symptomatic vertebral artery ostial occlusion, who underwent interventional recanalization between June 2020 and June 2022 at the Department of Neurology, the First Affiliated Hospital of Air Force Medical University, were retrospectively enrolled. Clinical and imaging data were analyzed to assess lesion characteristics, including the side of responsible lesion, the presence or absence of stump, the presence or absence of contralateral vertebral artery, the presence or absence of collateral compensation. Additionally, the mode of access, the handling of occluded segment of vertebral artery, the success of thrombectomy retrieval, and the perioperative and follow-up periods were examined.

Seventeen patients with symptomatic vertebral artery ostial occlusion underwent interventional opening, including 15 males and 2 females, with a median age of 66 years. There were 3 patients with right vertebral artery occlusion, 14 with left vertebral artery occlusion, and 13 with contralateral vertebral artery dysplasia. Eleven cases received compensatory blood supply from the thyrocervical trunk, while 9 cases had compensatory blood supply from the posterior communicating artery. The success rate of acute symptomatic vertebral artery initial occlusion was 88.8% (8/9). Seven patients had positive occlusion of the vertebral artery; one patient had reverse guidance of the thyrocervical trunk to open the occluded vertebral artery, and in one case, recanalization failed because the micro-guide wire could not pass through the occluded segment of the vertebral artery initial; The success rate of non-acute symptomatic vertebral artery initial occlusion was 87.5% (7/8). Six cases were occluded through the positive direction; one case was occluded through the contralateral hypoplastic vertebral artery reverse direction; and one case failed to recanalize because the guide wire could not find the occluded vertebral artery opening. Of the 17 patients with occluded vertebral artery, 10 had stump, and 7 had no stump.

There are six primary strategies for achieving interventional patency in patients with symptomatic vertebral artery ostial occlusion: the first is the antegrade patency, followed by thyrocervical trunk and occipital artery retrograde patency, then contralateral vertebral artery retrograde patency or posterior communicating artery retrograde patency, and finally direct puncture of the vertebral artery retrograde patency.