A Hybrid Surgery Option for Treating Symptomatic Extracranial Vertebral Artery Occlusion

Abstract

OBJECTIVE: To evaluate the technical feasibility and safety of a hybrid surgery approach combining vertebral artery endarterectomy and endovascular therapy for symptomatic extracranial vertebral artery occlusion (EVAO). METHODS: We conducted a retrospective case series study from June 2021 to January 2023 involving 16 patients with symptomatic EVAO who received hybrid surgery at our center. The patients’ clinical characteristics, angiographic information, recanalization rate, postprocedural complications, and outcomes were reviewed. RESULTS: This study included 16 patients with symptomatic EVAO. All recanalizations were successful, and no patients experienced symptomatic or asymptomatic cerebral infarction after recanalization. Six (37.5%) patients experienced perioperative complications, including three (18.8%) with Horner syndrome, two (12.5%) with hoarseness, and one (6.3%) with incision infection. All patients underwent clinical follow-up, with a median follow-up time of 7.0 (interquartile range [IQR]: 4–18) months. No patients developed cerebral infarction with posterior circulation, and their median modified Rankin scale score was 0. All patients underwent imaging follow-up, with a median follow-up time of 6.0 (IQR: 3–12) months. One (6.3%) patient experienced asymptomatic stent occlusion during the perioperative period. One (6.3%) patient was found to have severe restenosis at the proximal end of the vertebral artery near the stent, and underwent placement of a drug-eluting stent. The remaining 14 (87.5%) patients did not experience in-stent restenosis or occlusion. CONCLUSION: Hybrid surgery is a feasible treatment for patients with symptomatic EVAO. This preliminary study demonstrated that hybrid surgery may be effective and have a certain degree of security. Further large-scale prospective randomized controlled trials are required to demonstrate the safety and effectiveness of hybrid surgery in patients with symptomatic EVAO.