Angioplasty for intracranial symptomatic vertebrobasilar ischemia.
OBJECTIVE
Although anterior circulation disease has both medical and surgical treatment options, management of vertebrobasilar disease has predominantly had only medical options. Some patients remain symptomatic despite medical treatment, and angioplasty has been demonstrated to relieve critical stenoses. However, the elative safety and effectiveness of medical and surgical treatments is not clearly known. This report reviews the clinical characteristics, indications, and procedural risks of intracranial angioplasty in a series of patients with symptomatic posterior circulation ischemia.


METHODS
All patients undergoing angioplasty for critical intracranial vertebral or basilar artery stenosis at the University of California at San Francisco Medical Center between June 1986 and July 1999 were included in a retrospective record review. Clinical features and procedural complications were recorded.


RESULTS
Angioplasty was performed on 25 vessel lesions in 25 patients in whom medical therapy had failed. The patients ranged in age from 50 to 87 years. Of the 25 stenoses, 10 were intracranial vertebral, 9 vertebrobasilar junction, and 6 basilar in location. Angioplasty was effective in reducing the degree of stenosis by more than 40% in all 25 vessels. The overall risk of stroke or death was 28%, and the risk of disabling stroke or death was 16%.


CONCLUSIONS
Intracranial posterior circulation angioplasty is effective in the reduction of stenosis and can be performed with relative safety. Angioplasty can be considered as a treatment option in patients with recurrent ischemic symptoms despite medical therapy.
Department of Neurology, University of California, San Francisco, 94143-0114, USA. daryl.gress@ucsfmedctr.org
Daryl R
DR
Gress
Wade S
WS
Smith
Chris F
CF
Dowd
V
V
Van Halbach
Randall J
RJ
Finley
Randall T
RT
Higashida
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*