Angioplasty and stenting of basilar artery stenosis: technical case report.
OBJECTIVE
Symptomatic basilar artery stenosis has a poor prognosis. Treatment options are limited. Surgical bypasses are technically demanding and of no proven benefit. Percutaneous angioplasty is associated with a significant complication rate, because of intraplaque dissection, restenosis secondary to vessel recoil, and embolic phenomena. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. We report a case of basilar artery stenosis that was treated using stent-assisted angioplasty.


METHODS
A 56-year-old woman experienced a vertebrobasilar ischemic stroke, from which she recovered. Magnetic resonance angiography revealed severe proximal basilar artery stenosis. Brain Neurolite-single-photon emission computed tomographic scans revealed significantly decreased perfusion of the brainstem. Endovascular intra-arterial pressure measurements revealed a 35-mm Hg gradient across the lesion.


METHODS
The patient underwent uncomplicated angioplasty and stenting of the proximal basilar artery, with excellent angiographic results.


CONCLUSIONS
The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach for patients with basilar artery stenosis. Long-term follow-up monitoring is required to assess the durability of this approach.
Lanzino
G
G
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
Fessler
R D
RD
Miletich
R S
RS
Guterman
L R
LR
Hopkins
L N
LN
D015901:Angiography, Digital Subtraction; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000628:therapy*; D001488:Basilar Artery / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008875:Middle Aged; D015607:Stents; D015899:Tomography, Emission-Computed, Single-Photon