title: Combined endovascular and open surgery for four-vessel cerebrovascular occlusive disease.
abstract: OBJECTIVE
  To report a case of bilateral simultaneous percutaneous transluminal angioplasty and stenting of the intracranial vertebral arteries prior to staged bilateral carotid endarterectomy.
  
  
  METHODS
  A 68-year-old man presented with a 3-month history of recurrent, intermittent left-sided weakness and diplopia. Imaging defined bilateral 80% to 99% internal carotid artery stenoses and >90% stenoses of both distal vertebral arteries at the level of the foramen magnum. Bilateral intracranial vertebral artery stenting was performed, followed by staged carotid endarterectomies. No complications occurred, and the patient recovered uneventfully from all 3 procedures. He remains symptom- and event-free 20 months later.
  
  
  CONCLUSIONS
  Our initial success in this case indicates a role for percutaneous transluminal angioplasty and stenting as an alternative to open surgery for intracranial vertebral artery stenosis.
authors.affiliation: Department of Vascular Surgery, University of Sydney, NSW, Australia. msbarakate@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Barakate
authors.forename: C M
authors.initials: CM
authors.lastname: Fisher
authors.forename: M
authors.initials: M
authors.lastname: Appleberg
authors.forename: M A
authors.initials: MA
authors.lastname: Farrar
authors.forename: R V
authors.initials: RV
authors.lastname: Tse
authors.forename: T J
authors.initials: TJ
authors.lastname: Harrington
authors.forename: W
authors.initials: W
authors.lastname: Sorby
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002339:Carotid Arteries / Q000601:surgery*; D002533:Cerebral Angiography; D004691:Endarterectomy; D006801:Humans; D008297:Male; D011300:Preoperative Care; D015607:Stents; D014711:Vertebral Artery