[Combination of percutaneous balloon angioplasty and aggressive medical intervention improves symptomatic basilar artery stenosis with a tortuous access route: case report].
The prognosis of symptomatic intracranial artery stenosis (SIAS) by medical treatment is poor. Percutaneous balloon angioplasty (PTA) or stenting is effective for SIAS. However, recently, aggressive medical intervention (AMI) has progressed and some drugs have been reported to improve stenosis or prevent the progression of stenosis. We describe a case where combination of PTA and the AMI improved symptomatic basilar artery stenosis with a tortuous access route.


METHODS
A 78-year-old man was admitted to our hospital suffering from acute brain infarction due to severe basilar artery stenosis. The AMI including cilostazol, statin, and eicosapentaenoic acid failed to prevent recurrence of the brain infarction. We performed PTA and 45% of the residual stenosis remained. We continued the AMI and the stenosis improved to 30% after 3 months.


CONCLUSIONS
PTA with minimal risk should be considered for SIAS resistant to AMI. Even if residual stenosis remains, continuation of AMI may prevent recurrence of a brain infarction. The strategy of a combination of PTA with minimal risk and AMI may result in a better prognosis for SIAS.
Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Wakayama-city, Wakayama, Japan.
Kenichi
K
Kono
Yui
Y
Ito
Yuichi
Y
Miyazaki
Kotaro
K
Yasumori
Masahiro
M
Yasaka
Yasushi
Y
Okada
Shinji
S
Nagata
D000368:Aged; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology; D000077407:Cilostazol; D015118:Eicosapentaenoic Acid / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D013777:Tetrazoles / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D013777:Tetrazoles; D014665:Vasodilator Agents; D015118:Eicosapentaenoic Acid; D000077407:Cilostazol