Assessment of outcomes of emergent stenting in vertebrobasilar occlusion stroke: a single experience in a comprehensive stroke centre

In acute posterior circulation strokes, vertebrobasilar occlusions are typically associated with poorer outcomes than anterior circulation strokes. Previous trials had an overall mortality rate of 37%. However, few studies have addressed the benefit and safety of the emergent stenting in the successful recanalization at these complex occlusions. We studied whether clinical outcomes improved three months after the procedure. A retrospective analysis of acute vertebrobasilar occlusions patients who received emergent stenting was performed at our hospital. The vertebrobasilar occlusions comprised of tandem occlusions (defined as severe stenosis or occlusion of the vertebral artery ostium concomitant with the basilar artery occlusion) and isolated occlusions. Clinical and functional features and complication rates were recorded. The primary objective was the variation in clinical outcomes as measured by modified Rankin Scale (mRS) score at 3 months. We conducted a retrospective study of a prospectively maintained database with 56 patients, however only 38 patients were eligible with major vessel occlusion in posterior circulation who underwent mechanical thrombectomy between December 2020 and November 2023. Although all patients had successful recanalization (modified treatment in cerebral infarction [mTICI]≥2b), there was only one (2.6%) patient experienced symptomatic intracranial hemorrhage. At three months following emergent stenting in vertebrobasilar occlusion stroke, 25 (65.8%) patients had a favorable outcome (mRS≤3). 22 (57.9%) patients had good outcomes (mRS≤2), with 5 (13.2%) tandem and 17 (44.7%) isolated lesions. While this study provides preliminary insights into the role of emergent stenting in the vertebrobasilar occlusions stroke, its retrospective approach, small sample size, lack of a control group, and potential selection bias limit the generalizability of findings.