Objective To explore the safety and efficacy of using the"bare-support"technique via radial artery approach under local anesthesia for endovascular treatment of severe vertebral-basilar artery stenosis.Methods Patients were retrospectively and continuously enrolled from June 2021 to March 2023,admitted to the Department of Neurology at Zhongnan Hospital of Wuhan University,and underwent endovascular treatment for severe vertebral-basilar artery stenosis under local anesthesia via the radial artery approach using the"bare-support"technique.Baseline and clinical data,including sex,age,hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation,history of stroke,smoking history,preoperative the National Institutes of Health stroke scale(NIHSS)score,and preoperative modified Rankin scale score were collected from the patient.Surgical-related data were also collected,including site of stenosis(vertebral artery V4 segment,basilar artery,vertebral artery V4 segment+basilar artery),stenosis rate(70％-90％,＞90％-99％),target lesion vessel diameter,lesion vessel length,vertebral-subclavian angle,vertebral-subclavian distance,use of distal access catheter,anesthesia method(local anesthesia,general anesthesia),presence of isolated vertebral artery(opposite vertebral artery occlusion),whether the distal access catheter was shaped,position of the distal access catheter in the vertebral artery(vertebral artery V2 segment,V3 segment,V4 segment),endovascular treatment method(simple balloon dilation,balloon dilation+self-expanding stent,balloon dilation stent),intraoperative cerebral ischemia symptoms,severe intraoperative cerebral ischemia symptoms,and whether the surgical approach was changed.Gather clinical outcomes and follow-up status,including the surgery success rate(surgery completed via radial artery access with a residual stenosis rate of the target vessel less than 30％after endovascular treatment,and modified thrombectomy in cerebral infarction[mTICI]grade 3),neurological function impairment within 72hours after surgery,perioperative complications(disabling stroke,nondisabling stroke,puncture site complications),in-stent restenosis within six months post-surgery(≥50％narrowing reoccurring at the location or within 5 mm diameter of stent after previous stent placement or angioplasty)and stroke relapses(another stroke event after the first stroke).Base on whether the distal access catheter was shaped,the patients were divided into a shaping group and a non-shaping group.Compare the baseline and clinical data,as well as the vertebral-subclavian angle and distance between the groups.Results A total of 33 patients who underwent endovascular treatment for severe vertebral-basilar artery stenosis using the"bare stent"technique via the radial artery approach were included,comprising 29 males and 4 females,aged between 42 to 76 years,with an average age of(62±9)years.Among them,13 were in the shaping group,20 was in the non-shaping group.(1)No significant differences in clinical or baseline data were observed between the two groups(all P＞0.05).Compared with the non-shaping group,patients from the shaping group had significantly smaller vertebral-subclavian angle([62.80±21.57]° vs.[109.57±28.63]°,P＜0.01),and significantly longer vertebral-subclavian distance([13.58±7.35]mm vs.[6.13±4.31]mm,P=0.002).(2)Among the 33 cases,30(90.9％)were completed under local anesthesia,while 3 cases(9.1％)with isolated vertebral arteries experienced severe ischemic intolerance during surgery and were switched to general anesthesia.The success rate of endovascular treatment for severe vertebrobasilar artery stenosis via transradial artery approach was 93.9％(31/33),with only 2 cases switched to transfemoral approach due to difficulty in establishing the radial artery access also succeeded in completing the surgery.Neurological function impairment occurred in 5 cases(15.2％)within 72 hours postoperatively.The perioperative complication rate was 9.1％(3/33),including 1 case(3.0％)of disabling stroke and 2 cases(6.1％)of non-disabling stroke.No puncture site complications had occurred.During the 6-month follow-ups,in-stent restenosis occurred in 2 cases(6.1％),with no recurrence of stroke.Conclusions Endovascular treatment of severe vertebrobasilar artery stenosis using the"bare-support"technique via the radial artery under local anesthesia is safe and feasible.Larger prospective randomized controlled trials are needed to validate these findings.

Objective To explore the safety and efficacy of using the"bare-support"technique via radial artery approach under local anesthesia for endovascular treatment of severe vertebral-basilar artery stenosis.Methods Patients were retrospectively and continuously enrolled from June 2021 to March 2023,admitted to the Department of Neurology at Zhongnan Hospital of Wuhan University,and underwent endovascular treatment for severe vertebral-basilar artery stenosis under local anesthesia via the radial artery approach using the"bare-support"technique.Baseline and clinical data,including sex,age,hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation,history of stroke,smoking history,preoperative the National Institutes of Health stroke scale(NIHSS)score,and preoperative modified Rankin scale score were collected from the patient.Surgical-related data were also collected,including site of stenosis(vertebral artery V4 segment,basilar artery,vertebral artery V4 segment+basilar artery),stenosis rate(70％-90％,＞90％-99％),target lesion vessel diameter,lesion vessel length,vertebral-subclavian angle,vertebral-subclavian distance,use of distal access catheter,anesthesia method(local anesthesia,general anesthesia),presence of isolated vertebral artery(opposite vertebral artery occlusion),whether the distal access catheter was shaped,position of the distal access catheter in the vertebral artery(vertebral artery V2 segment,V3 segment,V4 segment),endovascular treatment method(simple balloon dilation,balloon dilation+self-expanding stent,balloon dilation stent),intraoperative cerebral ischemia symptoms,severe intraoperative cerebral ischemia symptoms,and whether the surgical approach was changed.Gather clinical outcomes and follow-up status,including the surgery success rate(surgery completed via radial artery access with a residual stenosis rate of the target vessel less than 30％after endovascular treatment,and modified thrombectomy in cerebral infarction[mTICI]grade 3),neurological function impairment within 72hours after surgery,perioperative complications(disabling stroke,nondisabling stroke,puncture site complications),in-stent restenosis within six months post-surgery(≥50％narrowing reoccurring at the location or within 5 mm diameter of stent after previous stent placement or angioplasty)and stroke relapses(another stroke event after the first stroke).Base on whether the distal access catheter was shaped,the patients were divided into a shaping group and a non-shaping group.Compare the baseline and clinical data,as well as the vertebral-subclavian angle and distance between the groups.Results A total of 33 patients who underwent endovascular treatment for severe vertebral-basilar artery stenosis using the"bare stent"technique via the radial artery approach were included,comprising 29 males and 4 females,aged between 42 to 76 years,with an average age of(62±9)years.Among them,13 were in the shaping group,20 was in the non-shaping group.(1)No significant differences in clinical or baseline data were observed between the two groups(all P＞0.05).Compared with the non-shaping group,patients from the shaping group had significantly smaller vertebral-subclavian angle([62.80±21.57]° vs.[109.57±28.63]°,P＜0.01),and significantly longer vertebral-subclavian distance([13.58±7.35]mm vs.[6.13±4.31]mm,P=0.002).(2)Among the 33 cases,30(90.9％)were completed under local anesthesia,while 3 cases(9.1％)with isolated vertebral arteries experienced severe ischemic intolerance during surgery and were switched to general anesthesia.The success rate of endovascular treatment for severe vertebrobasilar artery stenosis via transradial artery approach was 93.9％(31/33),with only 2 cases switched to transfemoral approach due to difficulty in establishing the radial artery access also succeeded in completing the surgery.Neurological function impairment occurred in 5 cases(15.2％)within 72 hours postoperatively.The perioperative complication rate was 9.1％(3/33),including 1 case(3.0％)of disabling stroke and 2 cases(6.1％)of non-disabling stroke.No puncture site complications had occurred.During the 6-month follow-ups,in-stent restenosis occurred in 2 cases(6.1％),with no recurrence of stroke.Conclusions Endovascular treatment of severe vertebrobasilar artery stenosis using the"bare-support"technique via the radial artery under local anesthesia is safe and feasible.Larger prospective randomized controlled trials are needed to validate these findings.