Optical coherence tomography evaluation of vessel wall microstructure before and after endovascular stent treatment for intracranial vertebrobasilar atherosclerotic stenosis.

BACKGROUND

Intracranial vertebral artery stenosis is a significant cause of ischemic stroke. Intravascular optical coherence tomography (OCT), known for its high resolution, can accurately analyze the microstructure components of the stenotic vessel wall. Although widely used in the cardiovascular system, its application in intracranial atherosclerotic diseases of intracranial arteries remains limited. This study aimed to utilize OCT as a novel imaging modality for vessel wall microstructure analysis in patients with intracranial atherosclerosis. Specifically, it analyzed the vascular walls of 15 patients with severe intracranial vertebrobasilar artery stenosis before and after endovascular stent treatment.

METHODS

A retrospective analysis was conducted from 7 March 2023 to 26 March 2024 at The First Affiliated Hospital of Harbin Medical University, focusing on the neurosurgical endovascular stent treatment and OCT evaluation of 15 cases of intracranial vertebrobasilar artery stenosis (70-90%). All lesions were located in the V4 segment of the vertebral artery.

RESULTS

OCT accurately identified the vessel wall microstructures in patients with intracranial vertebrobasilar artery stenosis before and after endovascular stent treatment. Identified structures included fibrous plaques, lipid plaques, calcified plaques, ruptured plaques, intraluminal thrombosis, vascular dissection, microchannels, macrophages, cholesterol crystals, healing plaques, tissue prolapse, stent thrombosis, and stent adherence. Following endovascular stent treatment and OCT only one patient experienced symptomatic complications.

CONCLUSIONS

The evaluation of intracranial vertebrobasilar arteries using OCT was shown to be safe and feasible. This technique aids in the diagnosis and treatment of cerebrovascular diseases. However, this preliminary study should be validated through prospective large-scale studies.