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

Best Revascularisation Approach for Posterior Circulation Strokes With Isolated Vertebral : the BRAVO Retrospective Analysis

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.

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