Angioplasty and Stenting of Basilar Artery Stenosis: Technical Case Report

Angioplasty and Stenting of Basilar Artery Stenosis: Technical Case Report AbstractOBJECTIVE AND IMPORTANCE:Symptomatic basilar artery stenosis has a poor prognosis. Treatment options are limited. Surgical bypasses are technically demanding and of no proven benefit. Percutaneous angioplasty is associated with a significant complication rate, because of intraplaque dissection, restenosis secondary to vessel recoil, and embolic phenomena. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. We report a case of basilar artery stenosis that was treated using stent-assisted angioplasty.CLINICAL PRESENTATION:A 56-year-old woman experienced a vertebrobasilar ischemic stroke, from which she recovered. Magnetic resonance angiography revealed severe proximal basilar artery stenosis. Brain Neurolite- single-photon emission computed tomographic scans revealed significantly decreased perfusion of the brainstem. Endovascular intra-arterial pressure measurements revealed a 35-mm Hg gradient across the lesion.INTERVENTION:The patient underwent uncomplicated angioplasty and stenting of the proximal basilar artery, with excellent angiographic results.CONCLUSION:The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach for patients with basilar artery stenosis. Long-term follow-up monitoring is required to assess the durability of this approach. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Angioplasty and Stenting of Basilar Artery Stenosis: Technical Case Report

Angioplasty and Stenting of Basilar Artery Stenosis: Technical Case Report

TECHNICAL CASE REPORT stenosis after an g io p la sty is considered Angioplasty and Stenting of Basilar a satisfactory result (23). Additionally, the restenosis rate after intracranial an­ Artery Stenosis: Technical Case Report giop lasty is sign ifican t (30). Prospective trials in volvin g the coro n ary circulation have sh o w n that angioplasty-assisted Giuseppe Lanzino, M.D., Richard D. Fessler, M.D., stenting of co ro n a ry stenosis improves o u tco m es and long-term patency (7,18). Robert S. Miletich, M.D., Ph.D., The a d v a n ta g e s of stent-assisted angio­ Lee R. Guterman, Ph.D., M.D., L. Nelson Hopkins, M.D. plasty over an g io p lasty alone include Department of Neurosurgery (GL, RDF, LRG, LNH) and Dent Neurological Institute (RSM), the exclusion of dislodged plaque and School of Medicine and Biomedical Sciences, University at Buffalo, State University of regions of dissection from the vessel lu­ New York, Buffalo, New York m en, as well as the prevention of vessel recoil and rupture. W e report a case of h ig h -g rad e proxim al basilar artery ste­ O BJEC T IV E A N D IM PO R T A N C E: Symptomatic basilar artery stenosis has a nosis that w as treated using angioplasty poor prognosis. Treatment options are limited. Surgical bypasses are and stenting, with excellen t clinical and technically demanding and of no proven benefit. Percutaneous angio­ an g io g rap h ic results. plasty is associated with a significant complication rate, because of intraplaque dissection, restenosis secondary to vessel recoil, and embolic CASE REPO RT phenomena. A new generation of intravascular stents that are flexible This 56-year-old w om an with a history enough to navigate the tortuosities of the vertebral artery may provide a of diabetes and hypertension presented in new therapeutic approach. W e report a case of basilar artery stenosis that May 1998 with a vertebrobasilar stroke was treated using stent-assisted angioplasty. involving the...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199908000-00047
Publisher site
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Abstract

AbstractOBJECTIVE AND IMPORTANCE:Symptomatic basilar artery stenosis has a poor prognosis. Treatment options are limited. Surgical bypasses are technically demanding and of no proven benefit. Percutaneous angioplasty is associated with a significant complication rate, because of intraplaque dissection, restenosis secondary to vessel recoil, and embolic phenomena. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. We report a case of basilar artery stenosis that was treated using stent-assisted angioplasty.CLINICAL PRESENTATION:A 56-year-old woman experienced a vertebrobasilar ischemic stroke, from which she recovered. Magnetic resonance angiography revealed severe proximal basilar artery stenosis. Brain Neurolite- single-photon emission computed tomographic scans revealed significantly decreased perfusion of the brainstem. Endovascular intra-arterial pressure measurements revealed a 35-mm Hg gradient across the lesion.INTERVENTION:The patient underwent uncomplicated angioplasty and stenting of the proximal basilar artery, with excellent angiographic results.CONCLUSION:The availability of new flexible intravascular stents, allowing access to tortuous proximal intracranial vessels, provides a new therapeutic approach for patients with basilar artery stenosis. Long-term follow-up monitoring is required to assess the durability of this approach.

Journal

NeurosurgeryOxford University Press

Published: Aug 1, 1999

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