Fu JF, Zhang XL, Lee SY, Zhang FM, You JS. Subintimal recanalization for non-acute occlusion of intracranial vertebral artery in an emergency endovascular procedure: A case report. World J Clin Cases 2023; 11(24): 5762-5771 [PMID: 37727719 DOI: 10.12998/wjcc.v11.i24.5762]
Corresponding Author of This Article
Jin-Song You, PhD, MD, Department of Cerebrovascular Disease, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. youjs73@163.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 26, 2023; 11(24): 5762-5771 Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5762
Subintimal recanalization for non-acute occlusion of intracranial vertebral artery in an emergency endovascular procedure: A case report
Jun-Feng Fu, Xiang-Ling Zhang, Shun-Yin Lee, Fo-Ming Zhang, Jin-Song You
Jun-Feng Fu, Xiang-Ling Zhang, Shun-Yin Lee, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Fo-Ming Zhang, Jin-Song You, Department of Neurosurgery, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Author contributions: Fu JF performed the manuscript writing; Zhang XL edited the figure of the article; Lee SY acquired the data; You JS and Zhang FM contributed to conceptualization and supervision; All authors contributed to the article and approved the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Song You, PhD, MD, Department of Cerebrovascular Disease, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. youjs73@163.com
Received: May 11, 2023 Peer-review started: May 11, 2023 First decision: July 7, 2023 Revised: July 17, 2023 Accepted: July 31, 2023 Article in press: July 31, 2023 Published online: August 26, 2023
Abstract
BACKGROUND
Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult, particularly when the microwire enters the subintima. Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion, there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.
CASE SUMMARY
A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities, poor speech, and dizziness. After admission, imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries (ICVAs). On the fourth day of admission, the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed. During this procedure, a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen. Two stents were implanted in the subintima. The patient's Modified Rankin Scale was 1 at three months postoperatively.
CONCLUSION
We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure. However, we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.
Core Tip: Technical challenges arise during endovascular recanalization of non-acute intracranial artery occlusions, particularly when the microwire enters the subintima. To our knowledge, this article details the first successful case of subintimal recanalization for non-acute intracranial vertebral artery occlusion in a patient with progressive ischemic stroke. However, we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.
