title: The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting.
abstract: BACKGROUND
  Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin. Strokes affecting this area carry a significantly higher risk for subsequent stroke or death as compared to anterior circulation strokes. Embolic protection device (EPD) use for carotid artery stenosis has translated into percutaneous interventions of proximal vertebral artery (VA) stenosis. However, the use of EPDs when treating intracranial lesions has yet to be studied and may not be feasible as the vessel caliber is frequently smaller than in existing devices.
  
  
  OBJECTIVE
  The aim of this study is to describe a proximal aspiration technique used during the treatment of intracranial VA and basilar artery (BA) atherosclerotic disease.
  
  
  METHODS
  Proximal embolic protection was utilized during the treatment of intracranial VA/BA stenosis with angioplasty and stenting in patients with medically refractory disease.
  
  
  RESULTS
  Three patients with severe symptomatic posterior circulation stenosis refractory to medical management were treated with angioplasty and stenting utilizing proximal aspiration. Pre- and post-treatment angiograms and MRIs were compared. Treated vascular stenoses were significantly improved, without new neurological deficits or ischemic injury identified on imaging.
  
  
  CONCLUSIONS
  The proposed technique of proximal embolic protection may help overcome the challenge of embolus propagation inherent to the treatment modality that was encountered during the treatment of intracranial VA/BA stenosis.
authors.affiliation: Departments of Neurosurgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, La., USA.
authors.forename: Silvia I
authors.initials: SI
authors.lastname: Gesheva
authors.affiliation: Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, La., USA.
authors.forename: Laurel H
authors.initials: LH
authors.lastname: Hastings
authors.affiliation: Departments of Neurosurgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, La., USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wilson
keywords: Atherosclerosis; Embolic protection device; Stroke; Vertebrobasilar insufficiency