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Angioplasty and stenting of basilar artery stenosis: technical case report
G Lanzino1, R D Fessler, R S Miletich
1Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
Insights
Stent-assisted angioplasty offers a promising new treatment for severe basilar artery stenosis, a condition with limited options. This technique successfully treated a patient with vertebrobasilar stroke, showing excellent results.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Symptomatic basilar artery stenosis (BAS) carries a poor prognosis with limited effective treatments.
- Traditional surgical bypass is complex and unproven; percutaneous angioplasty has high complication rates.
- New flexible intravascular stents may enable safer treatment of tortuous intracranial vessels in BAS.
Observation:
- A 56-year-old woman presented with a vertebrobasilar ischemic stroke.
- Severe proximal basilar artery stenosis was confirmed by MRI angiography.
- Brain imaging showed reduced brainstem perfusion, and pressure measurements revealed a significant gradient across the stenosis.
Findings:
- The patient underwent successful angioplasty and stenting of the proximal basilar artery.
- The procedure was uncomplicated and yielded excellent angiographic results.
- This demonstrates the feasibility of using new flexible stents in complex intracranial anatomy.
Implications:
- Flexible intravascular stents offer a novel therapeutic option for basilar artery stenosis.
- This approach may improve outcomes for patients with severe BAS.
- Long-term studies are needed to confirm the durability and safety of stent-assisted angioplasty for BAS.
Objective 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.