Therapeutic basilar artery occlusion for management of medically refractory basilar artery stenosis: case report.
OBJECTIVE
To describe a novel therapeutic approach (endovascular basilar artery occlusion) to a notoriously difficult-to-manage clinical condition (actively symptomatic high-grade basilar artery stenosis) on the basis of assessment of the patient-specific mechanism of disease.


METHODS
An 81-year-old woman presented with recurrent episodes of brainstem ischemia refractory to aggressive medical therapy. Cerebral angiography revealed a high-grade proximal basilar artery stenosis. On the basis of clinical presentation and angiographic findings, the pathogenesis of this complex of symptoms was thought to be embolic rather than hemodynamic.


METHODS
Endovascular coil occlusion of the basilar artery was used, with excellent outcome (cessation of ischemic symptoms and independent level of functioning at 1 yr).


CONCLUSIONS
Successful endovascular management of intracranial occlusive disease requires understanding of the mechanism responsible for the patient's symptoms.
Horowitz
Michael
M
Departments of Neurosurgery and Radiology, University of Pittsburgh Medical Center and Presbyterian University Hospital, Pittsburgh, Pennsylvania 15213, USA. horowitzmb@upmc.edu
Jovin
Tudor G
TG
Gebel
James M
JM
D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D014715:Vertebrobasilar Insufficiency / Q000628:therapy*